CPT 45386
Global 000 ActiveColonoscopy w/balloon dilat
CPT 45386 Billing & Documentation Guide
CPT code 45386 (Colonoscopy w/balloon dilat) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.68, a non-facility practice expense RVU of 15.95, and a malpractice RVU of 0.44, a total non-facility RVU of 20.07 and facility RVU of 5.61. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $694, though rates vary from $588.11 to $912.53 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 45386, 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 45386 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 45386 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 45386
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.68 | 3.68 |
| Practice Expense RVU | 15.95 | 1.49 |
| Malpractice RVU | 0.44 | 0.44 |
| Total RVU | 20.07 | 5.61 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 45386
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 | $765.67 | $194.18 | $716.77 - $912.53 | 29 |
| Florida | $686.05 | $201.46 | $654.31 - $714.67 | 3 |
| Georgia | $648.92 | $188.17 | $615.64 - $682.2 | 2 |
| Illinois | $666.19 | $199.52 | $632.28 - $696.95 | 4 |
| Michigan | $643.85 | $190.33 | $625.9 - $661.79 | 2 |
| North Carolina | $629.36 | $178.74 | $629.36 - $629.36 | 1 |
| New York | $743.05 | $204.24 | $639.35 - $791.51 | 5 |
| Ohio | $624.12 | $183.17 | $624.12 - $624.12 | 1 |
| Pennsylvania | $661.56 | $188.48 | $625.86 - $697.25 | 2 |
| Texas | $661.73 | $186.24 | $621.37 - $699.83 | 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 45386
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 45386 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 45386
What does CPT code 45386 mean? +
CPT code 45386 represents: Colonoscopy w/balloon dilat. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 45386? +
The 2026 Medicare national average non-facility payment for CPT 45386 is $694. Rates range from $588.11 to $912.53 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 45386? +
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 45386? +
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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