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See a sample rate comparisonCPT 45190 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.
Destruction Rectal Tumor, Destruction Of Rectal Tumor Eg Electrodesiccation Electrosurgery Laser Ablation Laser Resection Cryosurgery Transanal Approach
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 45190 |
National average reimbursement for CPT 45190 by major payers:
$860.37
$914.23
$967.44
$1,122.53
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CPT 45190
5 of 25 sample ratesHigher to lower in this preview
Canonsburg General Hospital
Highmark Health
$7,408.95Published rateWest Wilshire Medical Surgical Center Inc.
West Wilshire Medical Surgical C
$2,260.00Published rateSurgery Center Of Gilbert LLC, Surgery Center Of Gilbert
Surgery Center Of Gilbert, LLC
$1,731.00Published rateBarnet Dulaney Perkins Eye Center, PC, Bdpec Asc Tucson 5th St
Barnet Dulaney Perkins Eye Center PLLC
$1,145.00Published rateTampa Bay Eye Surgery Center, LLC
Tampa Bay Eye Surgery Center LLC
$840.00Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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