Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance

CPT 45331 is the billing code for "Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance". For flexible sigmoidoscopy with submucosal injection for therapeutic purposes

Medicare pays approximately $272.03 for CPT 45331 (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 45331 has a total RVU of 6.73, broken down as: Work RVU 2.30, Practice Expense RVU 4.20, and Malpractice RVU 0.23. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 45331 include: Indication for sigmoidoscopy and injection; Location of injection sites; Substance injected; Volume injected at each site. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 45331: Includes sigmoidoscopy. Includes directed submucosal injection Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 45331 include: 59 (Distinct procedural service if performed with other procedures), 52 (Reduced services if procedure not completed), 53 (Discontinued procedure due to patient condition). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 45331 is 15-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.