CPT 45121 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 |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 62 - Co-Surgeons |
| Complexity Level | High |
| CMS | $1,702.07 Physician Fee Schedule |
National average reimbursement for CPT 45121 by major payers:
$2,200.61
$2,311.77
$2,406.91
$2,824.85
| 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 45121 | ||||||
United | 45121 | $1306.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $1184.00 | 1124594338 - CHARLOTTE SURGERY CENTER, LLC | 561449531 - (NC) CHARLOTTE SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $875.00 | 1730296997 - DAY SURGERY LIMITED LIABILITY | 550737750 - (WV) DAY SURGERY LLC | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $380.00 | 1881699106 - CENTER FOR DAY SURGERY | 621845006 - (TN) CENTER FOR DAY SURGERY | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $5554.00 | 1598096802 - MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC, MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER | 264276930 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $388.00 | 1831153527 - THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC. | 521532190 - (MD) THE SURGICAL CENTER OF GREATER ANNAPOLIS INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $550.00 | 1386749943 - QUAIL SURGICAL AND PAIN MANAGEMENT CENTER, LLC | 880391609 - (NV) QUAIL SURGICAL & PAIN MANAGEMENT CENTER, LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $350.00 | 1720270879 - AKSTEIN EYE CENTER, ASC, AKSTEIN EYE CENTER, ASC | 581597344 - (GA) AKSTEIN EYE CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $5554.00 | 1679065759 - MEMORIAL HERMANN SURGERY CENTER BRAZORIA, LLC | 830759140 - (TX) MEMORIAL HERMANN SURGERY CENTER BRAZORIA LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $3348.22 | 1578208435 - NPI SURGERY CENTER LLC | 852578527 - (NE) NPI SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $2200.00 | 1487933172 - MT. SCOTT SURGERY CENTER, LLC | 832600045 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $1064.00 | 1023349909 - PICCARD SURGERY CENTER, LLC | 270433723 - (MD) PICCARD SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $800.00 | 1629256961 - BELMONT/HARLEM SURGERY CENTER, LLC | 412237612 - (IL) BELMONT/HARLEM SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $1955.00 | 1790945145 - MANSFIELD SURGICAL PLAZA LLC, MANSFIELD SURGERY CENTER | 271835675 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45121 | $983.00 | 1003813221 - UNIVERSITY SURGERY CENTER LTD | 742894406 - (FL) UNIVERSITY SURGERY CENTER LTD | FL | 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 45121 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45121 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 45121 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 |
|---|---|---|
| 45120-CPT | High | Proctectomy, Complete (For Congenital Megacolon), Abdominal And Perineal Approach; With Pull-Through Procedure And Anastomosis (Eg, Swenson, Duhamel, Or Soave Type Operation) |
| 45121-CPT | High | Proctectomy, Complete (For Congenital Megacolon), Abdominal And Perineal Approach; With Subtotal Or Total Colectomy, With Multiple Biopsies |
| 45123-CPT | High | Protectomy, Partial, Without Anastomosis, Perineal Approach |
| 45126-CPT | High | Pelvic Exenteration For Colorectal Malignancy With Proctectomy (With Or Without Colostomy) With Removal Of Bladder And Ureteral Transplantations And/Or Hysterectomy Or Cervicectomy With Or Without Removal Of Tube(S) With Or Without Removal Of Ovary(S) Or Any Combination Thereof |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45121. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45121 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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