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See a sample rate comparisonCPT 45100 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.
Biops Of Anorectal Wall Anal Approa (Eg Congenital Megacolon), Biopsy Of Anorectal Wall Anal Approach (Eg Congenital Megacolon)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45100 |
| Medicaid Fee Schedule | View Medicaid rates for 45100 |
National average reimbursement for CPT 45100 by major payers:
$390.31
$392.10
$432.48
$486.94
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CPT 45100
5 of 25 sample ratesHigher to lower in this preview
Connecticut Orthopaedic Surgery Center, LLC
$2,573.00Published rateArizona Advanced Endoscopy LLC
Arizona Advanced Endoscopy, LLC
$1,258.00Published rateEndoscopy Center Of North Carolina
$652.00Published rateDeaconess Hospital, Inc, <Unavail>
Deaconess Hospital Inc
$523.84Published rateLisa Renfro Surgery Center LLC
$420.00Published rate
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See a sample payer proposalCPT 45100 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45100 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 45100 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 |
|---|---|---|
| 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 |
| 45100-CPT | Moderate | Biops Of Anorectal Wall Anal Approa (Eg Congenital Megacolon), Biopsy Of Anorectal Wall Anal Approach (Eg Congenital Megacolon) |
| 45108-CPT | Moderate | Myomectomy Anorectal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45100 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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