CPT 45381
Global 000 ActiveColonoscopy submucous njx
CPT 45381 Billing & Documentation Guide
CPT code 45381 (Colonoscopy submucous njx) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.47, a non-facility practice expense RVU of 10.79, and a malpractice RVU of 0.42, a total non-facility RVU of 14.68 and facility RVU of 5.32. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $506.4, though rates vary from $432.71 to $655.86 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45381, 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 45381 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 45381 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 45381
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.47 | 3.47 |
| Practice Expense RVU | 10.79 | 1.43 |
| Malpractice RVU | 0.42 | 0.42 |
| Total RVU | 14.68 | 5.32 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45381
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 | $554.11 | $184.18 | $520.38 - $655.86 | 29 |
| Florida | $504.81 | $191.13 | $481.52 - $526.55 | 3 |
| Georgia | $476.68 | $178.43 | $454.1 - $499.26 | 2 |
| Illinois | $491.35 | $189.27 | $466.87 - $511.7 | 4 |
| Michigan | $474.05 | $180.5 | $460.78 - $487.33 | 2 |
| North Carolina | $461.11 | $169.43 | $461.11 - $461.11 | 1 |
| New York | $542.53 | $193.75 | $468.14 - $577.88 | 5 |
| Ohio | $459.08 | $173.65 | $459.08 - $459.08 | 1 |
| Pennsylvania | $484.95 | $178.72 | $460 - $509.9 | 2 |
| Texas | $484.38 | $176.59 | $456.89 - $509.86 | 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 45381
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45381 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 45381
What does CPT code 45381 mean? +
CPT code 45381 represents: Colonoscopy submucous njx. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45381? +
The 2026 Medicare national average non-facility payment for CPT 45381 is $506.4. Rates range from $432.71 to $655.86 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45381? +
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 45381? +
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 May 31, 2026.
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