CPT Code 45398Complete Billing & Coding Guide (2026)Colonoscopy w/band ligation
About CPT 45398
CPT 45398 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Colonoscopy w/band ligation". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 45398 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.
45398 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
NCCI Bundling Edits
10 pairsThese codes trigger National Correct Coding Initiative edits when billed with 45398. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
Billing 45398 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
Anesthesia service included in surgical procedure
Anesthesia service included in surgical procedure
Anesthesia service included in surgical procedure
Anesthesia service included in surgical procedure
Anesthesia service included in surgical procedure
More extensive procedure
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Standards of medical/surgical practice
Standards of medical/surgical practice
Multi-procedure NCCI edits hit surgical specialties harder than any other category. CO-97 denials on 45398 are frequently recoverable when the operative note documents distinct anatomic sites or staged steps. Our coders read the op note against the edit pair and pick the right modifier (XS preferred over modifier 59 for distinct structures).
Applicable Modifiers
Modifiers commonly paired with 45398 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier 24, 79, 78, and 58 on global-period claims are the highest-recovery surgical billing levers. 45398 carries a 000 global indicator. Our team flags every encounter inside an active global period for the right modifier decision.
Supporting ICD-10 Diagnoses
These diagnosis codes commonly support medical necessity for CPT 45398. Using the correct ICD-10 prevents CARC 50 denials. Payer rejects when the diagnosis doesn’t support the procedure.
Surgical CO-50 denials usually trace to ICD-10 specificity gaps (E11.9 instead of E11.65, M17.11 instead of M17.0, etc.). Our coders map every diagnosis to the highest-specificity code the chart supports, eliminating the common medical-necessity denial pattern.
Find the revenue leakage in your 45398 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Surgery (Digestive) claims. Our AAPC-certified team audits your last 90 days of 45398 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
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Related CPT Codes
Codes in the same family as 45398
Specialty billing guides
CPT 45398 is among the top codes profiled in these specialty billing guides.
Everything about CPT 45398
What does CPT code 45398 cover?
CPT 45398 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Colonoscopy w/band ligation". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 45398?
The national average Medicare payment for CPT 45398 is approximately $902.49 in a non-facility setting and $209.42 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 27.02 with a conversion factor of $33.4009.
What is the global period for CPT 45398?
CPT 45398 has a 0-day global period (indicator 000). Same-day E/M is bundled into the procedure, but office visits the next day or after are separately billable for unrelated care. Use modifier 24 for unrelated E/M during the global period.
What codes bundle with CPT 45398?
CPT 45398 has NCCI Procedure-to-Procedure edits with 10+ codes including 00731, 00732, 00811. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
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We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.