Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 45130 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.
Remove Rectum Out Of Anus, Removal Of Complete Rectal Prolapse (Condition Where Wall Of Rectum Falls Out Of Place And Protrudes From Anus).
| 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 GC - Service performed by resident under supervision AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45130 |
| Medicaid Fee Schedule | View Medicaid rates for 45130 |
National average reimbursement for CPT 45130 by major payers:
$1,369.68
$1,437.52
$1,544.38
$1,736.07
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 45130.
CPT 45130
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$11,727.00Published rateCalifornia Specialty Surgery Center, LLC, California Specialty Surgery Center, LLC
California Specialty Surgery Center, Lp
$1,607.00Published rateSurgery Center Of Coral Gables LLC, Coral Gables Surgery Center
Surgery Center Of Coral Gables LLC
$1,028.00Published rateHemlock Ambulatory Surgery Center
$535.00Published rateMidwest Eye Center
$150.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 45130 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45130 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 45130 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 Con, Proctectomy Complete (For Congenital Megacolon) Abdominal And Perineal Approach With Pull-Throughprocedure And Anastomosis (Eg Swenson Duhamel Or Soave Type Operation) |
| 45121-CPT | High | Removal Of Rectum And Colon, 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 |
| 45130-CPT | High | Remove Rectum Out Of Anus, Removal Of Complete Rectal Prolapse (Condition Where Wall Of Rectum Falls Out Of Place And Protrudes From Anus). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45130 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 45130) and we'll show you how you compare in 15 minutes or less.