CPT 45309 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| CMS | $202.17 Physician Fee Schedule |
National average reimbursement for CPT 45309 by major payers:
$239.00
$258.05
$280.69
$337.72
| 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 45309 | ||||||
United | 45309 | $1233.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $844.00 | 1215978945 - SAPLING GROVE AMBULATORY SURGERY CENTER, LLC | 204450153 - (TN) SAPLING GROVE AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $550.00 | 1376998666 - SWAN SURGERY CENTER, LLC | 812309409 - (AZ) SWAN SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $514.00 | 1023057916 - PHYSICIANS DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $703.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $3994.00 | 1376780916 - HAMILTON SURGERY CENTER LLC | 352061413 - (IN) HAMILTON SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $916.00 | 1043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER | 911954101 - (WA) SKIN SURGERY CENTER P. S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $628.00 | 1760808836 - OVERLAKE REPRODUCTIVE HEALTH INC PS., OVERLAKE REPRODUCTIVE HEALTH INC.- AMBULATORY SURGICAL FACILITY | 911796570 - (WA) OVERLAKE REPRODUCTIVE HEALTH, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $1845.00 | 1649655515 - PARKWAY SURGERY CENTER, LLC, PARKWAY SURGERY CENTER AT HORIZON RIDGE | 880403777 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $615.00 | 1306993464 - PACIFIC HILLS SURGERY CENTER LLC | 800180491 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $517.00 | 1821279720 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $2307.00 | 1679892913 - BELTWAY SURGERY CENTERS, L.L.C. | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $300.00 | 1831182799 - ZION EYE INSTITUTE, INC | 841432944 - (UT) ZION EYE INSTITUTE INC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $544.00 | 1588644520 - WESTGLEN ENDOSCOPY CENTER LLC, WESTGLEN ENDOSCOPY CENTER | 621707329 - WESTGLEN ENDOSCOPY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45309 | $2709.00 | 1346403854 - THE EMORY CLINIC INC, EMORY ORTHOPAEDIC SURGERY CENTER | 464115055 - (GA) EMORY AMBULATORY SURGERY CENTER AT DUNWOODY LLC | GA | 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 45309 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45309 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 45309 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 |
| 45309-CPT | Moderate | Proctosigmoidoscopy, Rigid; W Removal Sgl Tumor/Polyp/Lesion By Snare |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45309 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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