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    v1.0.30
    OpenPayerBilling CodesExcisional Laparoscopic Procedures on the RectumCPT cpt-45398-colonoscopy-band-ligation-hemorrhoid
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    CPT 45398: Flexible Colonoscopy with Band Ligation

    Medicare pays $940 on average nationally for this procedure.

    CPT code 45398 describes ligation of a structure (for example, a hemorrhoid) using a flexible band performed during a flexible colonoscopy; this is an endoscopic therapeutic procedure (band ligation) typically performed by a gastroenterologist in an outpatient endoscopy suite or ambulatory surgical center as part of lower gastrointestinal diagnostic and therapeutic care.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Clinical & Coding Specifications

    Clinical Context

    A 48-year-old patient presents to an outpatient endoscopy center with symptomatic internal hemorrhoids causing intermittent bright red rectal bleeding and prolapse despite conservative measures. After pre-procedure assessment and informed consent, the patient undergoes a diagnostic flexible colonoscopy with targeted hemorrhoid band ligation performed during the same session. The endoscopist identifies internal hemorrhoidal tissue and deploys one or more elastic bands via a flexible band ligator through the colonoscope to strangulate the hemorrhoid base.

    Typical workflow:

    • Pre-procedure evaluation and bowel preparation verification.

    • Procedural anesthesia or sedation administered per facility protocol.

    • Diagnostic flexible colonoscopy to inspect the colon and visualize anorectal pathology.

    • Identification of internal hemorrhoids amenable to rubber band ligation.

    • Deployment of elastic bands using a flexible banding device passed through the colonoscope (reported with 45398).

    • Post-procedure recovery, discharge instructions addressing analgesia, bleeding precautions, and follow-up for band sloughing and symptom assessment.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    45378Diagnostic colonoscopy, flexible; with biopsy, single or multipleFrequently performed prior to or during the same session to evaluate colonic mucosa and obtain biopsies if indicated.
    45380Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot snarePerformed when polyps are identified and removed during the same colonoscopic exam; distinct from band ligation of hemorrhoids.
    46945Hemorrhoidectomy, internal and external, any method; simple, single hemorrhoidSurgical excision option when band ligation is not suitable or fails; may follow failed 45398 in the care continuum.
    45385Colonoscopy, flexible; with control of bleeding, any methodUsed when endoscopic hemostasis for active lower GI bleeding is needed; may be reported if hemostatic therapy was performed separate from banding.
    99024Postoperative follow-up visit, typically in global periodUsed by surgeons or proceduralists for routine post-procedure follow-up related to the band ligation when payer allows.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    208000000X
    208D00000X
    163WX1100X
    261QA0005X
    207RS0010X
    2083T0002X
    207XX0801X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45395-LAPAROSCOPIC-TOTAL-PROCTECTOMY-END-COLOSTOMY

    CPT 45395: Laparoscopic Proctectomy with Colostomy

    CPT-45397-LAPAROSCOPIC-PROCTOCOLECTOMY-COLOANAL-ANASTOMOSIS-COLONIC-POUCH

    CPT 45397: Laparoscopic Restorative Proctocolectomy with Ileoanal Pouch

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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