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    v1.0.30
    OpenPayerBilling CodesEndoscopy Procedures on the RectumCPT cpt-45320-proctosigmoidoscopic-lesion-ablation
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    CPT 45320: Proctosigmoidoscopic Ablation of Lesion

    Medicare pays $254 on average nationally for this procedure.

    CPT code 45320 describes a proctosigmoidoscopic procedure in which a provider uses a rigid proctosigmoid scope to examine the anus, rectum, and sigmoid colon and ablate a tumor, polyp, or other lesion that is not amenable to standard techniques such as hot biopsy forceps or snare; service type: endoscopic lesion ablation; typical site of service: ambulatory surgery center or endoscopy suite (office-based procedure also possible depending on equipment and setting).

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with intermittent rectal bleeding and recent change in bowel habits is referred to colorectal surgery for evaluation. On flexible proctosigmoidoscopy performed in an outpatient endoscopy suite, a 1.5 cm sessile polyp in the distal sigmoid colon is visualized that is firm and has an irregular surface. Prior attempts at removal using hot biopsy forceps and a standard snare were unsuccessful due to lesion fixation and submucosal scarring. The provider converts to a rigid proctosigmoidoscopic approach and performs ablation of the lesion using adjunctive techniques (e.g., electrocautery ablation) through the proctosigmoidoscope. The procedure is performed with monitored anesthesia care in a procedure room; vital signs are documented throughout, lesions are photographed, and pathology specimens are sent if tissue is obtained. The patient is recovered in the outpatient area and given post-procedure instructions for bleeding and pain, with follow-up arranged for pathology and surveillance colonoscopy as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    45330Proctoscopy; diagnostic, separate procedurePerformed when diagnostic visualization without therapeutic ablation is indicated or as an initial evaluation.
    45380Colonoscopy, flexible; diagnostic, proximal to splenic flexureMay be performed before or after to evaluate more proximal colon for synchronous lesions.
    45385Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare techniqueAlternative endoscopic technique for polypectomy when lesion morphology permits snare removal.
    45331Proctosigmoidoscopy; diagnostic, with biopsyUsed when targeted biopsies are taken rather than ablative therapy.
    43235Upper GI endoscopy with biopsy, single or multipleNot directly related but represents another endoscopic procedure coding pattern; included for workflow context when combined procedures occur.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    207RC0000X
    207Q00000X
    363L00000X
    207ZF0201X
    207ZN0500X
    246ZB0500X
    213ER0200X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    D01.0Carcinoma in situ of colon
    D12.6Benign neoplasm of colon, unspecified
    K50.90Crohn's disease, unspecified, without complications
    K50.912Crohn's disease, unspecified, with intestinal obstruction
    K51.90Ulcerative colitis, unspecified, without complications
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding

    Showing 1–10 of 28

    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-45305-PROCTOSIGMOIDOSCOPY-WITH-BIOPSY

    CPT 45305: Proctosigmoidoscopy with Biopsy

    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-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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