CPT 45116 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 • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | High |
| CMS | $1,491.17 Physician Fee Schedule |
National average reimbursement for CPT 45116 by major payers:
$1,824.31
$2,077.55
$2,131.60
$2,555.38
| 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 45116 | ||||||
United | 45116 | $670.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $599.00 | 1407223019 - VALLEY OUTPATIENT SERVICES, LLC | 474866031 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $300.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $508.00 | 1437517745 - PREMIER AMBULATORY SURGERY CENTER | 475603095 - (NY) PREMIER AMBULATORY SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $402.00 | 1356490817 - CHRISTUS CABRINI SURGERY CENTER, LLC, CHRISTUS CABRINI SURGERY CENTER | 204705651 - CHRISTUS CABRINI SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $2172.00 | 1487371431 - BAYLOR SCOTT & WHITE SURGICARE WAXAHACHIE LLC | 920758698 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $306.00 | 1770551517 - SOUTHERN MARYLAND ENDOSCOPY CENTER | 522315798 - (MD) SOUTHERN MARYLAND ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $890.00 | 1619557519 - SCOTTSDALE MULTISPECIALTY SURGERY CENTER, PARADISE VALLEY MULTI SPECIALTY SURGERY CENTER | 833515797 - (AZ) SCOTTSDALE MULTISPECIALTY SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $798.00 | 1043845340 - NORTHEAST ENDOSCOPY LLC | 824889052 - (NY) NORTHEAST ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $410.00 | 1366809055 - DFW CHILDRENS SURGERY CENTER LLC | 475442947 - (TX) DFW CHILDRENS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $1368.00 | 1962505354 - PROVIDENCE HEALTH SERVICES OF WACO, PROVIDENCE HEALTH CENTER | 741109636 - (TX) ASCENSION PROVIDENCE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $545.00 | 1174601223 - BEL CLAIR AMBULATORY SURGICAL TREATMENT CENTER, LTD., BEL CLAIR SURGICAL CENTER | 371301073 - (IL) BEL CLAIR AMBULATORY SURGICAL TREATMENT CENTER LTD | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $300.00 | 1023039195 - CAPE SURGERY CENTER, LLC | 200649544 - (TN) CAPE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $380.00 | 1841298437 - WEST PALM OUTPATIENT SURGERY AND LASER CENTER LTD, NORTHPOINT SURGERY & LASER CENTER | 650592518 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45116 | $590.00 | 1568981975 - WEST MICHIGAN SURGICAL CENTER, LLC | 820593284 - (MI) WEST MICHIGAN SURGICAL CENTER, L | MI | 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 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 | Proctectomy W Part Resect Rectum |
| 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 |
| 45116-CPT | High | Proctectmy,Part,Anas;Transacral |
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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