Colonoscopy, flexible; with endoscopic mucosal resection

CPT 45390 is the billing code for "Colonoscopy, flexible; with endoscopic mucosal resection". For colonoscopy with endoscopic mucosal resection of colonic lesions

Medicare pays approximately $317.00 for CPT 45390 (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 45390 has a total RVU of 14.88, broken down as: Work RVU 5.80, Practice Expense RVU 8.50, and Malpractice RVU 0.58. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 45390 include: Indication for colonoscopy and EMR; Location and size of resected lesion; EMR technique used; Depth of resection. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 45390: Includes colonoscopy. Includes endoscopic mucosal resection Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 45390 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 45390 is 40-60 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.