CPT 45341 Flexible Sigmoidoscopy Reimbursement | OpenPayer

Summary & Overview

CPT 45341: Flexible Sigmoidoscopy with Endoluminal Ultrasound

CPT code 45341 denotes a flexible sigmoidoscopy combined with insertion of an ultrasound probe through the scope to perform endoluminal ultrasound of the rectum and sigmoid colon. This hybrid diagnostic procedure provides both direct endoscopic visualization and high-resolution intraluminal imaging, aiding evaluation of rectal and distal sigmoid pathology such as staging of rectal tumors, assessment of submucosal lesions, and guidance for local therapy decisions. Nationally, use of this code reflects clinical need for combined anatomic and sonographic assessment in lower gastrointestinal disease.

Key payers included in the national analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is used, expected sites of service, and common billing considerations tied to the CPT code. The publication summarizes benchmarks and utilization patterns, highlights relevant policy or coverage considerations affecting reimbursement and access, and clarifies documentation elements typically relevant to payers. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45341CPTSigmoidoscopyEndoluminal ultrasoundEndoscopyColorectal diagnosticsOutpatient procedureGastroenterology

Billing Code Overview

CPT code 45341 describes a diagnostic procedure in which a provider performs a flexible sigmoidoscopy with introduction of an ultrasound probe through the scope to perform an endoluminal ultrasound examination of the rectum and sigmoid colon. The procedure combines visualization of the anal canal, rectum, and sigmoid colon with intraluminal ultrasound imaging obtained via a probe passed through the instrument channel.

Service type: Endoscopic diagnostic procedure with endoluminal ultrasound (sigmoidoscopy-based ultrasound examination)
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in endoscopy suites where flexible sigmoidoscopy and ultrasound equipment are available.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to the outpatient endoscopy suite with rectal bleeding, intermittent change in bowel habits, and a history of incomplete colon evaluation. The gastroenterologist performs a flexible sigmoidoscopy with an ultrasound probe introduced through the instrument channel to perform endoluminal ultrasound of the rectum and distal sigmoid colon. The workflow includes pre-procedure assessment and informed consent, conscious sedation administered per facility protocol, insertion of the flexible sigmoidoscope with visualization of the anal canal, rectum, and sigmoid, targeted ultrasound imaging via the probe to assess wall layers or submucosal lesions, documentation of findings, and recovery monitoring in the post-anesthesia care area prior to discharge or transfer. Typical site of service is an outpatient endoscopy center or hospital outpatient department. The service type is diagnostic endoscopic evaluation with endoluminal ultrasonography of the rectosigmoid segment.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation component separate from facility/technical services.
`TC`	Technical component

CPT 45385: Colonoscopy with Snare Polypectomy

CPT-45317-PROCTOSIGMOIDOSCOPY-WITH-HEMOSTASIS

CPT 45317: Proctosigmoidoscopy with Hemostasis

CPT-45386-COLONOSCOPIC-BALLOON-DILATION-OF-COLONIC-STRICTURE

CPT 45386: Colonoscopic Balloon Dilation of Colonic Stricture

CPT-45381-COLONOSCOPY-FLEXIBLE-WITH-SUBMUCOSAL-INJECTION

CPT 45381: Colonoscopy, Flexible with Submucosal Injection

CPT-45382-COLONOSCOPY-ENDOSCOPIC-CONTROL-OF-COLONIC-BLEEDING

CPT 45382: Colonoscopy with Endoscopic Control of Colonic Bleeding

CPT-45315-PROCTOSIGMOIDOSCOPIC-POLYPECTOMY-MULTIPLE-LESIONS

CPT 45315: Proctosigmoidoscopic Removal of Multiple Lesions

CPT-45332-COLONOSCOPIC-FOREIGN-BODY-REMOVAL-FLEXIBLE-COLONOSCOPE

CPT 45332: Colonoscopic Removal of Foreign Body from Rectum and Colon

CPT-45333-FLEXIBLE-SIGMOIDOSCOPY-LESION-REMOVAL-HOT-BIOPSY

CPT 45333: Flexible Sigmoidoscopy with Lesion Removal (Hot Biopsy)

CPT-45305-PROCTOSIGMOIDOSCOPY-WITH-BIOPSY

CPT 45305: Proctosigmoidoscopy with Biopsy

CPT-45393-COLONOSCOPY-DECOMPRESSION-DILATED-COLON

CPT 45393: Flexible Colonoscopy with Colonic Decompression

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Taxonomy Code	Specialty	Notes
207RC0000X	Colon & Rectal Surgery	Surgeons who may perform diagnostic or therapeutic endoscopic procedures of the rectum and sigmoid.
207RG0300X	Gastroenterology	Gastroenterologists commonly perform flexible sigmoidoscopy with endoscopic ultrasound probes for rectal evaluation.
207RP1200X	General Surgery	General surgeons with endoscopy privileges may perform this procedure in operative or endoscopy settings.
208D00000X	Diagnostic Radiology	Radiologists may be involved in interpretation of specialized ultrasound imaging components in some facilities.
363A00000X	Anesthesiology	Anesthesiologists provide sedation services when deeper sedation or monitored anesthesia care is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	Common indication for sigmoidoscopic evaluation and endoluminal ultrasound to localize source of bleeding.
`K62.7`	Rectal prolapse	Sigmoidoscopy with ultrasound can assess rectal wall integrity and submucosal abnormalities related to prolapse.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Evaluation of distal colon for diverticular disease causing pain or bleeding; ultrasound may assess wall changes.
`K50.90`	Crohn disease, unspecified, without complications	Used when inflammatory bowel disease affects the rectosigmoid and transmural assessment with endoluminal ultrasound is needed.
`K51.90`	Ulcerative colitis, unspecified, without complications	Distal colitis evaluation and assessment of disease extent and wall involvement.
`R19.4`	Change in bowel habit	Symptom prompting diagnostic evaluation including sigmoidoscopy with ultrasound for structural causes.
`R10.9`	Abdominal pain, unspecified	Common presenting symptom leading to endoscopic evaluation of the distal colon and rectum.
`D12.6`	Benign neoplasm of colon, unspecified	Detection and characterization of submucosal or intramural lesions in the rectum/sigmoid via endoluminal ultrasound.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45378`	Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing	Performed when full colon evaluation is required beyond the sigmoid; may be performed prior to or after sigmoidoscopy if indicated.
`45310`	Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing	Closely related diagnostic sigmoidoscopy code without endoluminal ultrasound; used when ultrasound probe is not employed.
`76937`	Ultrasound guidance for needle placement (e.g., biopsy, aspiration), imaging supervision and interpretation	May be used for ultrasound-guided interventions if biopsy or aspiration is performed under ultrasound guidance during the endoscopic procedure.
`43239`	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Represents other commonly performed endoscopic diagnostic procedures in the same patient encounter for upper GI symptoms; may be part of combined evaluation.
`74261`	Radiologic examination, colon, single contrast barium enema, including small bowel follow-through when performed	Alternative or adjunct radiologic evaluation of the colon used in diagnostic workflows when endoscopy is contraindicated.

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