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 |
| CMS | $1,283.51 Physician Fee Schedule |
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 | $735.00 | 1043205040 - ST LUKES SURGICAL CENTER INC | 592407224 - (FL) ST LUKES SURGICAL CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1990.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $483.00 | 1972556942 - CHERRY HILL WOMEN'S CENTER, INC. | 232068660 - (NJ) CHERRY HILL WOMENS CENTER INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $501.00 | 1154369114 - CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC, CHRISTUS SURGERY CENTER - ALAMO HEIGHTS | 412092141 - (TX) CHRISTUS SRPASC - SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $805.00 | 1750362869 - EYE HEALTH EASTSIDE SURGERY CENTER | 680568557 - (OR) EYE HEALTH EASTSIDE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $706.00 | 1740246792 - PREMIER SURGERY CENTER OF LOUISVILLE LP, PREMIER SURGERY CENTER OF LOUISVILLE | 721378216 - (KY) PREMIER SURGERY CENTER OF LOUISVILLE LP | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1274.00 | 1316291867 - PACIFIC ENDOSCOPY LLC, ATHERTON ENDOSCOPY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1274.00 | 1295246981 - SURGCENTER OF SAN DIEGO, LLC, ADVANCED SURGERY CENTER OF NORTH COUNTY | 820615296 - (CA) SURGCENTER OF SAN DIEGO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1274.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $1064.00 | 1174777817 - INDIANA SPECIALTY SURGERY CENTER, LLC, INDIANA SPECIALTY SURGERY CENTER | 364775143 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $525.00 | 1649668781 - NORTHERN ARIZONA HEALTHCARE ORTHOPEDIC SURGERY CENTER, LLC | 472572645 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $420.00 | 1467472688 - WEST CLINIC ASTC, WEST CLINIC, PC | 621526296 - THE WEST CLINIC, PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $995.00 | 1336448968 - SOUTH ANCHORAGE SURGERY CENTER, LLC | 273925491 - (AK) SOUTH ANCHORAGE SURGERY CENTER LLC | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $319.00 | 1194716191 - AMBULATORY SURGICAL CENTER OF UNION COUNTY, LLC | 223740023 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 44130 | $175.00 | 1609223056 - HEART HEALTH CENTER, LLC | 473280746 - (AZ) HEART HEALTH CENTER LLC | AZ | 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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