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

CPT 45381 is the billing code for "Colonoscopy, flexible; with directed submucosal injection(s), any substance". For colonoscopy with submucosal injection of any substance for therapeutic or diagnostic purposes

Medicare pays approximately $422.77 for CPT 45381 (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 45381 has a total RVU of 9.02, broken down as: Work RVU 3.20, Practice Expense RVU 5.50, and Malpractice RVU 0.32. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 45381 include: Indication for colonoscopy; Location of injection site(s); Substance injected and volume; Purpose of injection. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 45381: Includes colonoscopy. Includes submucosal injection(s) Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 45381 include: 59 (Distinct procedural service if performed with other procedures), 33 (Preventive service when performed for screening), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 45381 is 20-40 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.