CPT 45126 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 • None • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 62 - Co-Surgeons • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45126 |
National average reimbursement for CPT 45126 by major payers:
$3,427.48
$3,724.70
$3,864.74
$4,535.90
| 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 45126 | ||||||
United | 45126 | $1028.00 | 1053574244 - SURGERY CENTER AT UNIVERSITY PARK, LLC, PREMIER SURGERY CENTER OF SARASOTA | 203757623 - (FL) SURGERY CENTER AT UNIVERSITY PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $250.00 | 1609399963 - INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | 814296629 - (AR) INTERVENTIONAL SURGERY INSTITUTE OF WHITE HALL LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $809.00 | 1497165179 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF PHOENIX | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $2172.00 | 1437552643 - BEAR CREEK SURGERY CENTER, LLC | 465530768 - (TX) BEAR CREEK SURGERY CENTER, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $1040.00 | 1881134815 - PORT JEFFERSON ASC, LLC | 371794376 - (NY) PORT JEFFERSON ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $424.00 | 1942483433 - PREMIER PHYSICIANS CENTERS, INC | 341783789 - (OH) PREMIER PHYSICIANS CENTERS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $464.00 | 1306162920 - SOUTH TEXAS AMBULATORY SURGERY CENTER, PLLC | 272293402 - (TX) SOUTH TEXAS AMBULATORY SURGERY CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $969.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $1686.00 | 1962676304 - 32ND STREET SURGERY CENTER, LLC | 261339811 - (MO) 32ND STREET SURGERY CENTER, L.L.C. | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $760.00 | 1912053570 - BELMAR AMBULATORY SURGICAL CENTER, LLC | 200680241 - (CO) BELMAR AMBULATORY SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $344.00 | 1306885256 - EYE SURGICAL CENTER, LLC, THE INSTITUTE FOR REFRACTIVE AND INTRAOCULAR SURGERY | 200318724 - (OH) EYE SURGICAL CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $1167.00 | 1669574539 - MANCHESTER SURGERY CENTER, LLC | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $980.00 | 1205845740 - THE UROLOGY CENTER LLC | 311579733 - (OH) THE UROLOGY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $670.00 | 1518272087 - SIPI AMBULATORY SURGERY CENTER | 300638923 - (ID) SIPI AMBULATORY SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45126 | $665.00 | 1427092279 - IPM SURGERY CENTERS LLC, SPINALCARE SURGICENTER | 330983021 - (CA) IPM SURGERY CENTERS, INC | CA | 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 45126 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45126 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 45126 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 |
| 45119-CPT | High | Proctectomy, Combined Abdominoperineal Pull-Through Procedure (Eg, Colo-Anal Anastomosis), With Creation Of Colonic Reservoir (Eg, J-Pouch), With Diverting Enterostomy When Performed |
| 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 45126. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45126 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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