CPT 45190 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 19 - Off Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45190 |
National average reimbursement for CPT 45190 by major payers:
$860.37
$914.23
$967.44
$1,147.88
| 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 45190 | ||||||
United | 45190 | $840.00 | 1326170036 - TAMPA BAY EYE SURGERY CENTER, LLC | 273286942 - (FL) TAMPA BAY EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $2859.00 | 1518356070 - DIGESTIVE DISEASE CENTER OF AMARILLO LLC | 752893120 - (TX) AMARILLO ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1645.00 | 1457378333 - BEAUMONT SURGICAL AFFILIATES, LTD, BAPTIST BEAUMONT SURGICAL AFFILIATES | 821773443 - (TX) BEAUMONT SURGICAL AFFILIATES | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1784.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $4263.00 | 1285912600 - THE EMORY CLINIC INC, THE EMORY CLINIC LAGRANGE SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1647.00 | 1598412256 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1986.00 | 1295988731 - BAPTIST EASTPOINT SURGERY CENTER, LLC | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1061.00 | 1336255827 - ROCKVILLE EYE SURGERY CENTER, LLC, PALISADES EYE SURGERY CENTER | 43713185 - (MD) PALISADES EYE SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1477.00 | 1669021283 - EL DORADO SURGERY CENTER LP, TUCSON ENDOSCOPY CENTER | 850474225 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $2859.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1779.00 | 1346508520 - FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | 270870899 - (NJ) FIRST GI ENDOSCOPY AND SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1400.00 | 1891770814 - REGIONAL HAND CENTER OF CENTRAL CALIFORNIA, INC | 770521088 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $2397.00 | 1558524298 - SAINT FRANCIS GI ENDOSCOPY L.L.C | 205540278 - (CT) SAINT FRANCIS GI ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $986.00 | 1790744175 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, PUYALLUP ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $2260.00 | 1316082365 - WEST WILSHIRE MEDICAL SURGICAL CENTER INC. | 954421811 - (CA) WEST WILSHIRE MEDICAL SURGICAL C | 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 45190 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45190 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 45190 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 |
|---|---|---|
| 45100-CPT | Moderate | Biopsy Anorectal Wall Anal Appr |
| 45135-CPT | High | Exc Rectal Procident W Anasto;Abdom |
| 45136-CPT | High | Excision Of Ileoanal Reservoir With Ileostomy |
| 45190-CPT | Moderate | 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 45190. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45190 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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