Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

CPT 45388 is the billing code for "Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)". For colonoscopy with ablation of colonic lesions using alternative method

Medicare pays approximately $2233.53 for CPT 45388 (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 45388 has a total RVU of 12.46, broken down as: Work RVU 4.60, Practice Expense RVU 7.40, and Malpractice RVU 0.46. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 45388 include: Indication for colonoscopy and ablation; Ablation method used; Location and size of ablated lesions; Number of lesions ablated. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 45388: Includes colonoscopy. Includes ablation therapy Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 45388 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 45388 is 30-50 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.