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    v1.0.30
    OpenPayerBilling CodesEndoscopy Procedures on the RectumCPT cpt-45305-proctosigmoidoscopy-with-biopsy
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    CPT 45305: Proctosigmoidoscopy with Biopsy

    Medicare pays $206 on average nationally for this procedure.

    CPT code 45305 describes a diagnostic proctosigmoidoscopy performed with a short rigid scope to examine the anus, rectum, and sigmoid colon, with one or more tissue biopsies taken; service type: endoscopic diagnostic procedure with biopsy; typical site of service: outpatient endoscopy suite, ambulatory surgery center, or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Clinical & Coding Specifications

    Clinical Context

    A 54-year-old patient presents to an outpatient surgical or endoscopy suite with rectal bleeding and intermittent lower abdominal cramping. After a focused history and anoscopic screening, the gastroenterologist recommends a diagnostic proctosigmoidoscopy with tissue biopsy to evaluate hemorrhoids, inflammatory changes, or a suspected distal colonic lesion. The procedure is performed under monitored anesthesia care or local anesthesia in the endoscopy unit. A rigid proctosigmoidoscope is inserted to examine the anal canal, rectum, and sigmoid colon to the extent allowed by the instrument; visualized abnormal mucosa is sampled with one or more forceps biopsies. Specimens are submitted to pathology with proper labeling and documentation of number and site. Postprocedural recovery includes short observation, discharge instructions for potential bleeding or pain, and pathology follow-up for definitive diagnosis.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    45300Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washingA diagnostic rigid proctosigmoidoscopy without biopsy; may be billed when no tissue is taken
    45310Proctosigmoidoscopy, rigid; with directed submucosal injection(s), any substancePerformed when therapeutic submucosal injection is required in addition to diagnostic evaluation
    45320Anoscopy, diagnostic; with biopsy, single or multipleBiopsy of the anal canal when the scope is limited to the anus; used when sampling excludes rectum/sigmoid
    45380Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)Performed when a more complete colonic evaluation is indicated beyond the reach of a rigid proctosigmoidoscope
    88305Pathology, surgical pathology, gross and microscopic examinationCPT 88305 is the typical pathology code for evaluation of small biopsy specimens obtained during the procedure

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207R00000X
    208800000X
    207L00000X
    207RM1200X
    376G00000X
    156FX1900X
    343900000X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    D12.0Benign neoplasm of cecum
    D12.1Benign neoplasm of appendix
    D12.2Benign neoplasm of ascending colon
    D12.6Benign neoplasm of colon, unspecified
    K21.9Gastro-esophageal reflux disease without esophagitis
    K29.70Gastritis, unspecified, without bleeding
    K50.90Crohn's disease, unspecified, without complications

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45300-PROCTOSIGMOIDOSCOPY-RIGID-DIAGNOSTIC

    CPT 45300: Diagnostic Proctosigmoidoscopy with Rigid Proctoscope

    CPT-45303-PROCTOSIGMOIDOSCOPY-WITH-STRICTURE-DILATION

    CPT 45303: Proctosigmoidoscopy with Stricture Dilation

    CPT-45307-PROCTOSIGMOIDOSCOPY-LOWER-GI-ENDOSCOPY

    CPT 45307: Proctosigmoidoscopy of Rectum and Sigmoid Colon

    CPT-45308-PROCTOSIGMOIDOSCOPIC-LESION-REMOVAL

    CPT 45308: Proctosigmoidoscopy with Removal of Single Lesion

    CPT-45309-PROCTOSIGMOIDOSCOPY-SNARE-EXCISION-LESION

    CPT 45309: Proctosigmoidoscopy with Snare Polypectomy

    CPT-45315-PROCTOSIGMOIDOSCOPIC-POLYPECTOMY-MULTIPLE-LESIONS

    CPT 45315: Proctosigmoidoscopy with Multiple Lesion Removal

    CPT-45317-PROCTOSIGMOIDOSCOPY-WITH-HEMOSTASIS

    CPT 45317: Therapeutic Proctosigmoidoscopy for Hemorrhage Control

    CPT-45320-PROCTOSIGMOIDOSCOPIC-LESION-ABLATION

    CPT 45320: Proctosigmoidoscopic Ablation of Lesion

    CPT-45321-PROCTOSIGMOIDOSCOPIC-DECOMPRESSION-SIGMOID-VOLVULUS

    CPT 45321: Proctosigmoidoscopic Decompression of Volvulus

    CPT-45327-PROCTOSIGMOIDOSCOPIC-STENT-PLACEMENT-FOR-RECTAL-SIGMOID-STRICTURE

    CPT 45327: Proctosigmoidoscopy with Stent Placement

    Showing 1–10 of 39

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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