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See a sample rate comparisonCPT 45005 Fee Schedule
Last Verified: October 2026
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.
I&D Abscess Rectum Submucous
| 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 51 - Multiple procedures GC - Service performed by resident under supervision AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45005 |
| Medicaid Fee Schedule | View Medicaid rates for 45005 |
National average reimbursement for CPT 45005 by major payers:
$342.17
$367.26
$406.00
$274.81
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CPT 45005
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, Emory Orthopaedic Surgery Center
Emory University
$3,022.00Published rateVenture Ambulatory Surgery Center
$1,368.00Published rateNeospine Puyallup Spine Center, LLC, Microsurgical Spine Center
Neospine Puyallup Spine Center LLC
$900.00Published ratePsa Ambulatory Surgery Center Of Killeen LLC
$600.00Published rateDermatology & Cosmetic Surgery Center PC
Dermatology Cosmetic Surgery Center PC
$400.00Published rate
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See a sample payer proposalCPT 45005 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45005 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 45005 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 |
|---|---|---|
| 44900-CPT | Moderate | I & D Of Appendiceal Abscess, Transabdom |
| 45000-CPT | Moderate | Transrectal Drainage Of Pelvic Abscess |
| 45005-CPT | Moderate | I&D Abscess Rectum Submucous |
| 45020-CPT | Moderate | Ncision & Drain Of Deep Supralevator Pelvirectal Or Retrorecta, Incision And Drainage Of Deep Supralevator Pelvirectal Or Retrorecta |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45005 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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