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 |
| CMS | $681.54 Physician Fee Schedule |
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 | $1295.00 | 1225036601 - TALLGRASS SURGICAL CENTER, LLC | 481243206 - (KS) TALLGRASS SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1645.00 | 1881193183 - SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | 823920550 - (TX) SOUTHSIDE SPECIALTY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1000.00 | 1770724122 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $527.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $5379.00 | 1659335438 - RESTON SURGERY CENTER, LP | 113654617 - (VA) RESTON SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1647.00 | 1598412256 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $950.00 | 1184784209 - AMERICAN SURGICAL CENTERS II, LLC, AMERICAN SURGICAL CENTERS | 383486345 - (MI) AMERICAN SURGICAL CENTERS II LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1037.00 | 1093779951 - EYE SURGERY AND LASER CLINIC, INC. | 562172461 - (NC) EYE SURGERY AND LASER CLINIC INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1900.00 | 1225439250 - ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | 465742281 - (TX) ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $2859.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1167.00 | 1558787614 - DIGESTIVE CARE ENDOSCOPY | 464923646 - (GA) DIGESTIVE CARE ENDOSCOPY | GA | 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 | $2119.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45190 | $1731.00 | 1245239656 - SURGERY CENTER OF GILBERT LLC, SURGERY CENTER OF GILBERT | 731596190 - (AZ) SURGERY CENTER OF GILBERT, LLC | AZ | 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 | 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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