CPT 45384
Global 000 ActiveColonoscopy w/lesion removal
CPT 45384 Billing & Documentation Guide
CPT code 45384 (Colonoscopy w/lesion removal) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.97, a non-facility practice expense RVU of 11.57, and a malpractice RVU of 0.61, a total non-facility RVU of 16.15 and facility RVU of 6.09. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $556.06, though rates vary from $475.05 to $715.37 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45384, 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 45384 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 45384 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 45384
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.97 | 3.97 |
| Practice Expense RVU | 11.57 | 1.51 |
| Malpractice RVU | 0.61 | 0.61 |
| Total RVU | 16.15 | 6.09 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45384
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 | $605.68 | $208.08 | $569.32 - $715.37 | 29 |
| Florida | $560 | $222.87 | $532.67 - $586.42 | 3 |
| Georgia | $525.85 | $205.3 | $501.6 - $550.1 | 2 |
| Illinois | $545.41 | $220.74 | $517.27 - $568.67 | 4 |
| Michigan | $524.16 | $208.64 | $508.43 - $539.88 | 2 |
| North Carolina | $506.18 | $192.68 | $506.18 - $506.18 | 1 |
| New York | $597.71 | $222.85 | $514.05 - $638.41 | 5 |
| Ohio | $505.97 | $199.19 | $505.97 - $505.97 | 1 |
| Pennsylvania | $534.11 | $204.98 | $506.62 - $561.59 | 2 |
| Texas | $532.71 | $201.91 | $503.2 - $559.78 | 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 45384
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45384 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 45384
What does CPT code 45384 mean? +
CPT code 45384 represents: Colonoscopy w/lesion removal. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45384? +
The 2026 Medicare national average non-facility payment for CPT 45384 is $556.06. Rates range from $475.05 to $715.37 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45384? +
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 45384? +
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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