CPT 45303 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 | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| CMS | $870.12 Physician Fee Schedule |
National average reimbursement for CPT 45303 by major payers:
$970.51
$1,176.42
$1,259.48
$1,497.12
| 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 45303 | ||||||
United | 45303 | $730.00 | 1770019200 - GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC, GEORGIA CATARACT AND EYE SPECIALTY CENTER | 461115901 - (GA) GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $2775.00 | 1659839686 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $1075.00 | 1811220429 - SURGICARE OF MANHATTAN, LLC | 205679305 - (NY) SURGICARE OF MANHATTAN LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $467.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $755.00 | 1477108900 - CLEARWAY SURGERY CENTER OF CRESTVIEW, LLC | 842479344 - (FL) CLEARWAY SURGERY CENTER OF CRESTVIEW LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $676.00 | 1922079896 - SOUTHERN OKLA SURGICAL SERVICES, ARDMORE REGIONAL SURGERY CENTER | 262814211 - (OK) ARDMORE REGIONAL SURGERY CENTER | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $3188.00 | 1487012480 - LAKE SPIVEY AMBULATORY SURGERY CARE, LLC, SPIVEY STATION SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $589.00 | 1225252257 - EYE ASSOCIATES SURGERY CENTER INC, CASCADIA SURGICAL | 274532347 - (WA) EYE ASSOCIATES SURGERY CENTER INC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $1276.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $639.00 | 1588756621 - HIGHLINE SOUTH AMBULATORY SURGERY CENTER, LLC, HIGHLINE SOUTH AMBULATORY SURGERY CENTER | 205001199 - (CO) HIGHLINE SOUTH AMBULATORY SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $1276.00 | 1922611714 - COLORADO UROLOGIC SURGERY CENTER LLC | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $570.00 | 1346349164 - SOUTHERN ALABAMA SURGERY CENTER LLC, SURGERY CENTER SOUTH | 621827534 - (AL) SOUTHERN ALABAMA SURGERY CENTER, LL | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $1528.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $500.00 | 1386820694 - URO-CENTER AMBULATORY SURGICAL CENTER LLC | 522267795 - (MD) UROCENTER AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45303 | $450.00 | 1568556488 - SUNCOAST EYE CENTER PA, SUNCOAST SURGERY INSTITUTE | 592337219 - (FL) SUNCOAST EYE CENTER PA | FL | 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 45303 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45303 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 45303 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 |
|---|---|---|
| 45300-CPT | Low | Proctosigmoidoscopy, Rigid; Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
| 45303-CPT | Moderate | Proctosigmoidoscopy; Dilate Direct |
| 45305-CPT | Moderate | Proctosigmoidoscopy W Biopsy |
| 45307-CPT | Moderate | Proctosigmoidoscopy; Remove Fb |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45303. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45303 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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