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See a sample rate comparisonCPT 45172 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Xcision Of Rectal Tumor Transanal Approa; Inclu Muscularis Pro, Excision Of Rectal Tumor Transanal Approach; Including Muscularis Pro
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45172 |
| Medicaid Fee Schedule | View Medicaid rates for 45172 |
National average reimbursement for CPT 45172 by major payers:
$994.29
$1,112.26
$1,174.39
$1,360.55
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CPT 45172
5 of 25 sample ratesHigher to lower in this preview
Physicians West Houston Surgical Center, LLC, Memorial Hermann Surgery Center Park Ten
$7,838.00Published rateWindsor Mill Surgery Center, LLC
Windsor Mill Surgery Center LLC
$3,188.00Published rateWestern PA Surgery Center, Wexford Branch, LLC, Western PA Surgery Center
Western PA Surgery Center
$1,743.00Published rateTallahassee Neurosugery Pain Management LLC, Tallahassee Memorial Center For Pain Management
Tallahassee Neurosugery Pain Management LLC
$1,368.00Published rateSurgery Center Of Eye Specialists Of Indiana, PC, Surgery Center
Surgery Center Of Eye Specialists Of Indiana PC
$619.00Published rate
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See a sample payer proposalCPT 45172 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45172 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 45172 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 |
|---|---|---|
| 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). |
| 45171-CPT | Moderate | Xcision Of Rectal Tumor Transanal Approa; Not Inclu Muscularis, Excision Of Rectal Tumor Transanal Approach; Not Including Muscularis |
| 45172-CPT | Moderate | Xcision Of Rectal Tumor Transanal Approa; Inclu Muscularis Pro, Excision Of Rectal Tumor Transanal Approach; Including Muscularis Pro |
| 45190-CPT | Moderate | Destruction Rectal Tumor, Destruction Of Rectal Tumor Eg Electrodesiccation Electrosurgery Laser Ablation Laser Resection Cryosurgery Transanal Approach |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45172. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45172 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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