Summary & Overview
CPT 45307: Lower GI Proctosigmoidoscopy
CPT code 45307 denotes a physician-performed lower gastrointestinal proctosigmoidoscopy, an endoscopic examination of the rectum and sigmoid colon. This procedure is commonly used for diagnostic evaluation of lower GI symptoms, targeted biopsies, and limited therapeutic maneuvers. Nationally, proctosigmoidoscopy is a frequently used lower GI diagnostic tool that influences colorectal disease detection, follow-up care, and procedural coding and billing practices across outpatient and ambulatory surgical settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage patterns and coding considerations relevant to these payers and highlights common clinical contexts in which CPT code 45307 is used.
Readers will find a concise clinical and billing primer on the procedure, typical sites of service, and the scope of services represented by the code. The report also summarizes available benchmarks and policy considerations that affect utilization and reimbursement, and provides context for clinicians, billing professionals, and policy analysts seeking a national perspective on coding, claims handling, and administrative practices for proctosigmoidoscopy. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 45307 describes a lower gastrointestinal proctosigmoidoscopy performed by a physician. The procedure involves direct endoscopic examination of the rectum and sigmoid colon using a rigid or flexible instrument to evaluate lower GI symptoms, perform biopsies, or conduct limited therapeutic interventions.
Service type: Diagnostic endoscopic procedure
Typical site of service: Outpatient endoscopy suite or ambulatory surgery center, and may also be performed in an office-based procedure room depending on clinical setting and equipment availability.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient gastrointestinal clinic or ambulatory surgery center with rectal bleeding, change in bowel habits, or distal lower abdominal pain. The patient has undergone pre-procedure evaluation including medical history, medication review (antithrombotics addressed), informed consent, and bowel preparation focused on the distal colon and rectum. The physician performs a diagnostic proctosigmoidoscopy using a rigid or flexible sigmoidoscope to visualize the rectum and sigmoid colon up to approximately 25–60 cm. Procedures commonly include inspection for hemorrhoids, fissures, inflammatory changes, or distal neoplasia; targeted biopsies; and limited therapeutic maneuvers such as lavage or foreign body removal. Typical workflow: pre-procedure assessment and consent, positioning and limited sedation or local anesthetic per protocol, insertion and advancement of the scope to the intended depth, documentation of findings and photo or video capture as applicable, performance of biopsies or minor treatments if indicated, recovery and post-procedure instructions, and documentation of pathology follow-up if biopsies obtained.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, uncomplicated service | Use for routine proctosigmoidoscopy without complications when reporting professional service. |