Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)

CPT 45315 is the billing code for "Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)". For flexible sigmoidoscopy to evaluate sigmoid colon and rectum

Medicare pays approximately $218.66 for CPT 45315 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 45315 has a total RVU of 5.49, broken down as: Work RVU 1.90, Practice Expense RVU 3.40, and Malpractice RVU 0.19. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 45315 include: Indication for sigmoidoscopy; Extent of examination; Findings in sigmoid colon; Any specimens collected. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 45315: Includes sigmoidoscopy. Includes specimen collection Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 45315 include: 52 (Reduced services if procedure not completed), 53 (Discontinued procedure due to patient condition), 33 (Preventive service when performed for screening). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 45315 is 10-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.