CPT 45349 Flexible Sigmoidoscopic Mucosal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45349: Flexible Sigmoidoscopic Mucosal Resection

CPT code 45349 denotes a mucosal resection performed with a flexible sigmoidoscope, a targeted endoscopic technique for removing mucosal lesions in the rectum and sigmoid colon. This procedure is clinically significant as it provides a minimally invasive option for diagnosis and treatment of distal colonic mucosal pathology, reducing the need for more extensive surgical intervention and facilitating outpatient management.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how CPT code 45349 is used across clinical settings, typical sites of service, and the procedural context for flexible sigmoidoscopic mucosal resection. The publication summarizes available benchmarks, procedural definitions, and relevant policy updates affecting coverage and coding practice.

Intended for clinical coders, billing professionals, and policy analysts, the report clarifies the clinical indication and service setting for CPT code 45349, highlights payer coverage considerations, and outlines the types of benchmarks and policy signals to monitor. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45349CPTendoscopyflexible sigmoidoscopymucosal resectionoutpatient surgerygastroenterologyprocedure coding

Billing Code Overview

CPT code 45349 describes a mucosal resection performed using a flexible sigmoidoscope, a minimally invasive endoscopic procedure targeting the rectum and sigmoid colon mucosa. The procedure involves visual inspection and removal of mucosal lesions through a flexible sigmoidoscope designed to access the distal colon.

Service type: Endoscopic mucosal resection (sigmoidoscopic)

Typical site of service: Endoscopy suite or ambulatory surgical center, often performed in outpatient settings where flexible sigmoidoscopy procedures are routinely conducted.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with intermittent rectal bleeding and a history of a sessile rectal polyp is scheduled for mucosal resection using a flexible sigmoidoscope (45349). The procedure is performed in an outpatient endoscopy suite with conscious sedation provided by an anesthesia professional. The clinical workflow includes pre-procedure consent and focused history (bleeding, anticoagulant use, bowel prep status), bowel preparation review, brief focused exam, topical and/or monitored sedation, flexible sigmoidoscopy to localize the lesion in the rectum or sigmoid colon, mucosal resection using snare or cap-assisted techniques, retrieval of resected tissue for pathology, hemostasis as needed (clips, cautery), recovery monitoring, and discharge with pathology follow-up and surveillance recommendations.

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.
`26`	Professional component	Use when reporting only the professional component of the service if a separate technical component exists.

CPT 45346: Flexible Sigmoidoscopy with Lesion Ablation

CPT-45317-PROCTOSIGMOIDOSCOPY-WITH-HEMOSTASIS

CPT 45317: Proctosigmoidoscopy with Hemostasis

CPT-45379-COLONOSCOPIC-FOREIGN-BODY-REMOVAL

CPT 45379: Colonoscopic Removal of Foreign Body

CPT-45393-COLONOSCOPY-DECOMPRESSION-DILATED-COLON

CPT 45393: Flexible Colonoscopy with Colonic Decompression

CPT-45327-PROCTOSIGMOIDOSCOPIC-STENT-PLACEMENT-FOR-RECTAL-SIGMOID-STRICTURE

CPT 45327: Proctosigmoidoscopic Placement of Colorectal Stent

CPT-45342-SIGMOIDOSCOPY-ULTRASOUND-FNA-BIOPSY-SIGMOID-RECTUM

CPT 45342: Sigmoidoscopy with Ultrasound-Guided FNA/Biopsy

45380-COLONOSCOPY-FLEXIBLE-PROXIMAL-TO-SPLENIC-FLEXURE-WITH

CPT 45380: Flexible Colonoscopy with Biopsy

45385-COLONOSCOPY-FLEXIBLE-PROXIMAL-TO-SPLENIC-FLEXURE-WITH

CPT 45385: Colonoscopy with Snare Removal of Tumor, Polyp, or Lesion

45330-SIGMOIDOSCOPY-FLEXIBLE-DIAGNOSTIC-INCLUDING-COLLECTION-OF

CPT 45330: Flexible Sigmoidoscopy, Diagnostic Evaluation

CPT-45388-COLONOSCOPIC-LESION-DESTRUCTION

CPT 45388: Flexible Colonoscopy for Lesion Destruction

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Taxonomy Code	Specialty	Notes
`207RC0000X`	Colon and Rectal Surgery	Common specialty performing mucosal resection of rectal/sigmoid lesions.
`207L00000X`	Gastroenterology	Frequently performs flexible sigmoidoscopy and endoscopic mucosal resection.
`207LP2900X`	Female Pelvic Medicine & Reconstructive Surgery	Occasionally involved if pelvic floor or rectal pathology overlaps (less common).
`208D00000X`	General Surgery	General surgeons with endoscopy training perform mucosal resections in appropriate settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	Rectal bleeding is a common presenting symptom prompting sigmoidoscopic mucosal resection to diagnose or treat bleeding lesions.
`K62.0`	Anal fissure	While not a primary indication for mucosal resection, fissures can coexist with anorectal symptoms evaluated during sigmoidoscopy.
`K62.9`	Disease of anus and rectum, unspecified	Used when a specific anorectal diagnosis is not yet established but sigmoidoscopy with resection is performed for diagnostic/therapeutic reasons.
`D12.6`	Benign neoplasm of colon, rectum, anus	Benign polyps in the rectum/sigmoid are common targets for mucosal resection via flexible sigmoidoscope.
`K50.911`	Crohn's disease of intestine with rectal bleeding	Inflammatory bowel disease with localized lesions or dysplasia may necessitate mucosal resection for diagnosis or therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Flexible sigmoidoscopy, diagnostic, including collection of specimen by brushing or washing, when performed (separate procedure)	Often performed as the initial diagnostic evaluation prior to `45349` when mucosal resection is not yet planned.
`45380`	Colonoscopy, flexible; with biopsy, single or multiple	May be performed before or after `45349` to evaluate proximal colon or obtain additional biopsy samples.
`45385`	Colonoscopy with removal of tumor(s), polypectomy by snare technique	Used for polypectomy of lesions in the colon; techniques overlap with mucosal resection performed via flexible sigmoidoscope.
`43239`	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Unrelated anatomically but listed as another endoscopic diagnostic with biopsy; included here as commonly billed endoscopic service in GI workflow when upper and lower evaluations are required.
`43248`	Data not available in the input.	Data not available in the input.

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