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See a sample rate comparisonCPT 45136 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.
Rectum Surgery With New Stoma, Surgery To Remove The Pouch Formed Of Small Intestine To Hold Stool (Ileoanal Reservoir) And To Connect The Small Bowel To A Surgically Created Opening In The Abdominal Wall (Stoma).
| 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 22 - Increased Procedural Services 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45136 |
| Medicaid Fee Schedule | View Medicaid rates for 45136 |
National average reimbursement for CPT 45136 by major payers:
$2,198.75
$2,399.37
$2,505.54
$2,895.49
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CPT 45136
5 of 25 sample ratesHigher to lower in this preview
Pacific Surgery Center, LLC
Pacific Surgery Center LLC
$3,348.22Published rateSquaw Peak Surgical Facility Inc
$1,073.00Published rateDoctors Outpatient Surgery Center Of Jupiter, LLC, Laser & Surgery Center Of The Palm Beaches
Drs. Outpatient Surgery Center Of Jupiter, LLC
$983.00Published rateUpper Valley Surgery Center
$544.00Published rateDigestive Health Specialists Endoscopy Center Arizona, LLC
Digestive Health Specialists Endoscopy Center Arizona LLC
$107.00Published rate
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See a sample payer proposalCPT 45136 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45136 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 45136 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 |
|---|---|---|
| 45135-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). |
| 45136-CPT | High | Rectum Surgery With New Stoma, Surgery To Remove The Pouch Formed Of Small Intestine To Hold Stool (Ileoanal Reservoir) And To Connect The Small Bowel To A Surgically Created Opening In The Abdominal Wall (Stoma). |
| 45150-CPT | Moderate | Divide Stricture Rectal |
| 45171-CPT | Moderate | Xcision Of Rectal Tumor Transanal Approa; Not Inclu Muscularis, Excision Of Rectal Tumor Transanal Approach; Not Including Muscularis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45136. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45136 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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