CPT 45123 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 • AS - PA/NP/CNS assistant at surgery • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $1,079.40 Physician Fee Schedule |
National average reimbursement for CPT 45123 by major payers:
$1,391.27
$1,476.05
$1,530.99
$1,825.29
| 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 45123 | ||||||
United | 45123 | $2991.00 | 1114922192 - GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER, LLC | 680380691 - (CA) GASTROENTEROLOGY ASSOC. ENDOSCOPY CENTER, LLC. DBA REDDING ENDOSCOPY | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $1668.00 | 1336184027 - EYE SURGICENTER LLC | 651005108 - (FL) EYE SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3826.00 | 1417566217 - CLEARWAY SURGERY CENTER OF EASTON, LLC | 851826166 - (MD) CLEARWAY SURGERY CENTER OF EASTON LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3474.00 | 1518208883 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $2410.00 | 1093757379 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3500.00 | 1285936641 - RIVERS EDGE AESTHETIC SURGERY, LLC | 271645468 - (SD) RIVERS EDGE AESTHETIC SURGERY LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $5040.00 | 1376228361 - SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | 923802390 - (OH) SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3451.00 | 1275281370 - MASS GENERAL BRIGHAM AMSURG INC. | 854372153 - (NH) MASS GENERAL BRIGHAM INCORPORATED | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $2645.00 | 1073505038 - PALMETTO SURGERY CENTER LLC | 582333248 - (SC) PALMETTO SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $4865.00 | 1881659613 - WEST HILLS SURGICAL CENTER LTD | 621625014 - (CA) WEST HILLS SURGICAL CENTER LTD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $9674.00 | 1689832438 - INOVA WOODBURN SURGERY CENTER LLC | 540620889 - INOVA HEALTH CARE SERVICES | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3750.00 | 1083169700 - FOUR PEAKS SURGERY CENTER, LLC | 813258200 - (AZ) FOUR PEAKS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $7029.00 | 1659335438 - RESTON SURGERY CENTER, LP | 113654617 - (VA) RESTON SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $5400.00 | 1437505948 - WATER LEAF SURGERY CENTER, LTD | 811356283 - (TX) WATER LEAF SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45123 | $3070.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 825301397 - (VA) VIRGINIA ENT SURGERY CENTER INC | VA | 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 45123 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45123 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 45123 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 45123. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45123 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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