CPT 44130 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 44130 |
National average reimbursement for CPT 44130 by major payers:
$1,591.33
$1,704.26
$1,893.41
$2,101.07
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 44130 | ||||||
United | 44130 | $150.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $550.00 | 1053597161 - 1800 MCDONOUGH ROAD SURGERY CENTER LLC | 261278011 - (IL) 1800 MCDONOUGH ROAD SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $375.00 | 1427577840 - DIALYSIS ACCESS CENTER OF CINCINNATI, INC. | 815023998 - (OH) DIALYSIS ACCESS CENTER OF CINCINNATI INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1418.00 | 1558612762 - QUEENS BOULEVARD ASC LLC | 274614930 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1274.00 | 1316947609 - AMARILLO ENDOSCOPY CENTER, LP | 752893120 - (TX) AMARILLO ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1603.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $850.00 | 1124406632 - COMPREHENSIVE PAIN ASC, LLC | 473944400 - (CA) COMPREHENSIVE PAIN ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $406.00 | 1396193033 - NEW BERLIN MEDICAL SERVICES, LLC | 811190440 - (WI) NEW BERLIN MEDICAL SERVICES LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $120.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $650.00 | 1629462759 - POLARIS CENTER FOR OUTPATIENT SPINE SURGERY | 473262863 - (GA) POLARIS CENTER FOR OUTPATIENT SPINE SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1030.00 | 1639261407 - ENDO GROUP, LLC, GARDEN CITY SURGICENTER | 200248148 - (NY) ENDO GROUP LLC DBA GARDEN CITY SURGICENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $893.00 | 1366456618 - SKYWAY SURGERY CENTER. LLC | 753035490 - (CA) SKYWAY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $2785.00 | 1144283649 - SKY RIDGE SURGERY CENTER LP | 223877040 - (CO) SKY RIDGE SURGERY CENTER LP | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $112.00 | 1093723900 - CARTER REAL ESTATE PROPERTIES INC, NORTH DALLAS SURGICARE | 752521630 - (TX) CARTER REAL ESTATE PROPERTIES INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $765.00 | 1578918124 - CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | 811657416 - (ND) CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 44130 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 44130 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 44130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 44120-CPT | High | Resect Sm Bowel W Anastomosis |
| 44121-CPT | Moderate | Enterectomy, Resection Of Small Intestine; Each Additional Resection And Anastomosis (List Separately In Addition To Code For Primary Procedure) |
| 44125-CPT | High | Resect Sm Bowel W Double Enterostom |
| 44130-CPT | High | Enteroenterostomy W Anastomosis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 44130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 44130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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