CPT 45338
Global 000 ActiveSigmoidoscopy w/tumr remove
CPT 45338 Billing & Documentation Guide
CPT code 45338 (Sigmoidoscopy w/tumr remove) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2, a non-facility practice expense RVU of 7.78, and a malpractice RVU of 0.25, a total non-facility RVU of 10.03 and facility RVU of 3.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $346.51, though rates vary from $294.32 to $453.34 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45338, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 45338 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 45338 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 45338
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2 | 2 |
| Practice Expense RVU | 7.78 | 1.01 |
| Malpractice RVU | 0.25 | 0.25 |
| Total RVU | 10.03 | 3.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45338
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $381.21 | $113.64 | $357.22 - $453.34 | 29 |
| Florida | $343.78 | $116.9 | $327.78 - $358.43 | 3 |
| Georgia | $324.8 | $109.08 | $308.55 - $341.05 | 2 |
| Illinois | $334.08 | $115.59 | $317.1 - $348.94 | 4 |
| Michigan | $322.56 | $110.23 | $313.48 - $331.64 | 2 |
| North Carolina | $314.59 | $103.61 | $314.59 - $314.59 | 1 |
| New York | $371.22 | $118.95 | $319.54 - $395.56 | 5 |
| Ohio | $312.47 | $106.02 | $312.47 - $312.47 | 1 |
| Pennsylvania | $330.86 | $109.37 | $313.24 - $348.48 | 2 |
| Texas | $330.76 | $108.14 | $311.03 - $349.26 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 45338
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45338 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0184T | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 45338
What does CPT code 45338 mean? +
CPT code 45338 represents: Sigmoidoscopy w/tumr remove. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45338? +
The 2026 Medicare national average non-facility payment for CPT 45338 is $346.51. Rates range from $294.32 to $453.34 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45338? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 45338? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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