CPT 45113 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 • 22 - Increased Procedural Services • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| CMS | $1,795.23 Physician Fee Schedule |
National average reimbursement for CPT 45113 by major payers:
$2,436.04
$2,533.48
$2,649.20
$3,105.16
| 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 45113 | ||||||
United | 45113 | $825.00 | 1093705774 - SURGICENTER OF MANSFIELD, LTD. | 311515255 - (OH) SURGICENTER OF MANSFIELD, LTD. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $789.00 | 1942335971 - PALOS SURGICENTER, LLC | 364404305 - (IL) PALOS SURGICENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $380.00 | 1841298437 - WEST PALM OUTPATIENT SURGERY AND LASER CENTER LTD, NORTHPOINT SURGERY & LASER CENTER | 650592518 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $719.00 | 1194770974 - HAMILTON ENDOSCOPY AND SURGERY CENTER, LLC | 223837967 - (NJ) HAMILTON ENDOSCOPY & SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $600.00 | 1710952882 - ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC | 813253496 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $183.00 | 1386885556 - THE ASC AT WAUGH CHAPEL | 263869837 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $811.00 | 1720156482 - LASER & SURGICAL EYE CENTER LLC | 931194986 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $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 | 45113 | $2172.00 | 1184689010 - PARK CITIES SURGERY CENTER, LLC, PARK CITIES SURGERY CENTER | 562357079 - (TX) PARK CITIES SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $675.00 | 1063750867 - MENLO PARK SURGERY CENTER, LLC. | 263669436 - (NJ) MENLO PARK SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $375.00 | 1164697009 - BOX HILL SURGERY CENTER LLC | 262454678 - (MD) BOX HILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $319.00 | 1497296198 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER II | 814079161 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $1274.00 | 1376906354 - PREMIER AT EXTON SURGERY CENTER, LLC | 474302293 - (PA) PREMIER AT EXTON SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $1477.00 | 1437191731 - EL DORADO SURGERY CENTER LP, TUCSON SURGERY CENTER | 850474225 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45113 | $555.00 | 1811300403 - SUMMIT SURGERY CENTER | 465701676 - (CO) SUMMIT SURGERY CENTER | CO | 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 45113 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45113 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 45113 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 |
|---|---|---|
| 45111-CPT | High | Proctectomy W Part Resect Rectum |
| 45112-CPT | High | Proctectmy,Comb.Pull-Thru Proc,1-2 |
| 45113-CPT | High | Proctectomy, Partial, With Rectal Mucosectomy, Ileoanal Anastomosis, Creation Of Ileal Reservoir (S Or J), With Or Without Loop Ileostomy |
| 45114-CPT | High | Proctectomy W Anastomos Abd+Transac |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45113 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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