CPT 45330
Global 000 ActiveDiagnostic sigmoidoscopy
CPT 45330 Billing & Documentation Guide
CPT code 45330 (Diagnostic sigmoidoscopy) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.82, a non-facility practice expense RVU of 5.5, and a malpractice RVU of 0.12, a total non-facility RVU of 6.44 and facility RVU of 1.61. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $223.1, though rates vary from $187.26 to $297.45 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45330, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 45330 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 45330 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 45330
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.82 | 0.82 |
| Practice Expense RVU | 5.5 | 0.67 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 6.44 | 1.61 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45330
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $247.92 | $57.02 | $231.34 - $297.45 | 29 |
| Florida | $219.51 | $57.64 | $209.03 - $228.76 | 3 |
| Georgia | $207.48 | $53.58 | $196.03 - $218.93 | 2 |
| Illinois | $212.65 | $56.77 | $201.38 - $223.35 | 4 |
| Michigan | $205.53 | $54.05 | $199.64 - $211.42 | 2 |
| North Carolina | $201.35 | $50.83 | $201.35 - $201.35 | 1 |
| New York | $239.08 | $59.1 | $204.73 - $255.01 | 5 |
| Ohio | $199.15 | $51.86 | $199.15 - $199.15 | 1 |
| Pennsylvania | $211.86 | $53.84 | $199.82 - $223.9 | 2 |
| Texas | $212.12 | $53.29 | $198.28 - $225.35 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 45330
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45330 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0184T | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 45330
What does CPT code 45330 mean? +
CPT code 45330 represents: Diagnostic sigmoidoscopy. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45330? +
The 2026 Medicare national average non-facility payment for CPT 45330 is $223.1. Rates range from $187.26 to $297.45 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45330? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 45330? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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