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See a sample rate comparisonCPT 45160 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.
Xcision Of Rectal Tumor By Proctotomy Transsacral/Transcoccyge, Excision Of Rectal Tumor By Proctotomy Transsacral Or Transcoccygeal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45160 |
| Medicaid Fee Schedule | View Medicaid rates for 45160 |
National average reimbursement for CPT 45160 by major payers:
$1,278.02
$1,351.99
$1,412.02
$1,628.13
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CPT 45160
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Preston Road, Ltd., Doctors United Surgery Center
Memorial Hermann Surgery Center Preston Road Ltd
$5,048.00Published rateMarion Surgery Center, LLC
Marion Surgery Center LLC
$2,353.00Published rateRegency Surgery Center, LLC
Regency Surgery Center LLC
$1,727.00Published rateMid-Bronx Endoscopy Center LLC
Midbronx Endoscopy Center LLC
$1,273.00Published rateJohn P Lydon Dpm, Bethesda Ambulatory Surgical Center
John P Lydon, Dpm
$475.00Published rate
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See a sample payer proposalCPT 45160 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45160 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 45160 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). |
| 45150-CPT | Moderate | Divide Stricture Rectal |
| 45160-CPT | High | Xcision Of Rectal Tumor By Proctotomy Transsacral/Transcoccyge, Excision Of Rectal Tumor By Proctotomy Transsacral Or Transcoccygeal |
| 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 45160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45160 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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