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See a sample rate comparisonCPT 45116 Fee Schedule
Last Verified: October 2026
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.
Proctectomy Partial W/ Anastomsis; Transsacral Approa Only (Kra, Proctectomy Partial With Anastomosis; Transsacral Approach Only (Kra
| 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 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45116 |
| Medicaid Fee Schedule | View Medicaid rates for 45116 |
National average reimbursement for CPT 45116 by major payers:
$1,824.31
$2,077.55
$2,131.60
$2,498.50
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CPT 45116
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$17,689.00Published rateKnoxville Orthopaedic Surgery Center LLC
$1,100.00Published rateCenter For Advanced Reproductive Services, PC, Ambulatory Surgical Center At Reproductive Services
Center For Advanced Reproductive Services, P.C.
$640.00Published ratePremier Ambulatory Surgery Center
$508.00Published rateLudwick Laser & Surgery Center, LLC
$200.00Published rate
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See a sample payer proposalCPT 45116 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45116 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 45116 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 | Partial Removal Of The Rectum, Surgical Removal Of A Portion Of The Rectum. The Remaining Healthy Segments Of The Rectum Are Reconnected. |
| 45113-CPT | High | Proctectomy Partial With Rec, Proctectomy Partial With Rectal Mucosectomy Ileoanalanastomosis Creation Of Ileal Reservoir (S Or J) With Or Without Loop Ileostomy |
| 45114-CPT | High | Proctectomy Partial W/ Anastomsis; Abdomi & Transsacral Appr, Proctectomy Partial With Anastomosis; Abdominal And Transsacral Appr |
| 45116-CPT | High | Proctectomy Partial W/ Anastomsis; Transsacral Approa Only (Kra, Proctectomy Partial With Anastomosis; Transsacral Approach Only (Kra |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45116 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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