Does 45390 require prior authorization?

No, 45390 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 45390?

Medicare facility rate: $290.25. Non-facility rate: $290.25. Work RVU: 5.89.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.89

Facility

$290.25

Non-Facility

$290.25

The submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671.
Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
A colonoscopy may be billed when a sigmoidoscope is used only if the bowel is sufficiently short that the entire colon can be examined and this fact is clearly documented in the clinical record.
An incomplete colonoscopy (inability to advance the colonoscope to the cecum or colon‑small intestine anastomosis due to unforeseen circumstances) is billed using codes 44388, 45378, G0105 or G0121 with modifier -53.
When the colonoscopy procedure is unusual or difficult, report modifier -22 (unusual procedural services) on the claim.

A55937 — Billing and Coding: Diagnostic Colonoscopy

J09

L33671 — Diagnostic Colonoscopy

J09

L38812 — Diagnostic Colonoscopy

J12

A58428 — Billing and Coding: Diagnostic Colonoscopy

J12

L34213 — Diagnostic and Therapeutic Colonoscopy

Ask Verity about documentation requirements, denial risks, or coverage in your state.