CPT 44405 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure • 53 - Discontinued procedure • 52 - Reduced Services |
| Complexity Level | Moderate |
| CMS | $522.72 Physician Fee Schedule |
National average reimbursement for CPT 44405 by major payers:
$683.62
$780.02
$736.51
$1,004.46
| 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 44405 | ||||||
United | 44405 | $770.75 | 1912090317 - NIZAR CHARAFEDDINE | 274758285 | OH | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1000.28 | 1720463524 - SHEHRIYAR MEHERSHAHI | 541586601 - CARILION HEALTHCARE CORPORATION | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1042.19 | 1144523549 - PRATYUSHA PARAVA | 752780722 - (TX) PERMIAN GASTROENTEROLOGY ASSOCIATES | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $488.05 | 1881860484 - VIJAYA DASARI | 472145394 - (TX) NORTH TEXAS GASTROENTEROLOGY PA | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $833.76 | 1881604460 - SHAHID ALI | 760194878 - (TX) GASTROENTEROLOGY CONSULTANTS, P.A. | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1139.84 | 1225128903 - JAMES TROTTER | 942854057 - IHC HEALTH SERVICES INC | ID | Gastroenterology Physician (207RG0100X) |
United | 44405 | $713.83 | 1093854010 - NITESH VACHHANI | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1145.58 | 1245422419 - HARI SAYANA | 237441353 - MONONGALIA COUNTY GENERAL HOSPITAL COMPANY | WV | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1402.10 | 1326381054 - SHAWN SHAH | 131623978 | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1536.22 | 1710938279 - MACK MITCHELL | 756002868 | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $810.34 | 1730434648 - TANIMA JANA | 760459500 - U T PHYSICIANS | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $625.32 | 1245284801 - SILVIA SY | 274455437 - (TX) TEXAS GASTROENTEROLOGY INSTITUTE, P.A. | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $671.22 | 1619942778 - DIGESTIVE & LIVER SPECIALISTS | 10593260 - (TX) DIGESTIVE AND LIVER SPECIALISTS OF HOUSTON | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $777.79 | 1396065645 - IMAD AHMAD | 752896138 - MEDHEALTH | TX | Gastroenterology Physician (207RG0100X) |
United | 44405 | $1026.07 | 1467806778 - TAMNEET BASRA | 300520570 - (TX) METHODIST HOSPITAL | TX | Gastroenterology Physician (207RG0100X) |
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 44405 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 44405 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 44405 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 |
|---|---|---|
| 44401-CPT | High | Colonoscopy Through Stoma; Diagnostic, Including Collection Of Specimenss By Brushing Or Washing When Performed With Ablation Of Tumors, Polyps, Or Other Lesionss Inc |
| 44403-CPT | Moderate | Colonoscopy Through Stoma; Diagnostic, Including Collection Of Specimens(S) By Brushing Or Washing When Performed; With Endoscopic Mucosal Resection |
| 44404-CPT | Moderate | Colonoscopy Through Stoma; Diagnostic, Including Collection Of Specimens(S) By Brushing Or Washing When Performed; With Directed Submucosal Injections(S), Any Substance |
| 44405-CPT | Moderate | Colonoscopy Through Stoma; Diagnostic, Including Collection Of Specimens(S) By Brushing Or Washing When Performed; With Transendoscopic Balloon Dilation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 44405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 44405 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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