CPT 45315 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 • 59 - Distinct Procedural Service • SG - Scene to Hospital ESRD facility • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $218.66 Physician Fee Schedule |
National average reimbursement for CPT 45315 by major payers:
$273.11
$274.79
$301.86
$352.90
| 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 45315 | ||||||
United | 45315 | $1390.00 | 1700888658 - WESTON OUTPATIENT SURGICAL CENTER LTD, WESTON OUTPATIENT SURGICAL CENTER | 650930629 - (FL) WESTON OUTPATIENT SURGICAL CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $480.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $596.00 | 1457695116 - SOUND PAIN ALLIANCE, MT. BAKER SURGERY CENTER | 823663428 - SOUND PAIN ALLIANCE | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1179.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $700.00 | 1649250218 - LORAIN SURGERY CENTER, LLC | 201641777 - (OH) LORAIN SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $482.00 | 1740228790 - CAPITAL SURGERY CENTER LLC | 522325983 - (MD) CAPITAL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $373.00 | 1205978780 - MOUNTAIN HOME SURGERY CENTER | 454157268 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $684.00 | 1467442657 - HOLY REDEEMER AMBULATORY SURGERY CENTER, LLC | 233020527 - (PA) HOLY REDEEMER AMBULATORY SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1100.00 | 1861458507 - BRASS PARTNERSHIP IN COMMENDAM | 721097827 - (LA) BRASS PARTNERSHIP IN COMMENDAM | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1233.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1814.00 | 1730277575 - BEDFORD AMBULATORY SURGICAL CENTER, LLC | 20519727 - (NH) BEDFORD AMBULATORY SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $575.00 | 1578147484 - EPIC SURGERY CENTER LLC | 844244016 - (AZ) EPIC SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $875.00 | 1518402205 - KINGWOOD ASC, LP, NORTH HOUSTON CARDIOVASCULAR SURGERY CENTER | 471873201 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1128.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45315 | $1052.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS 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 45315 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45315 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 45315 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 |
|---|---|---|
| 45110-CPT | High | Proctectomy;Complete,Comb,1-2 Stg |
| 45300-CPT | Low | Proctosigmoidoscopy, Rigid; Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
| 45305-CPT | Moderate | Proctosigmoidoscopy W Biopsy |
| 45315-CPT | Moderate | Procto-Sigmoidoscopy, Rigid; With Removal Of Multiple Tumors, Polyps, Or Other Lesions By Hot Biopsy Forceps, Bipolar Cautery Or Snare Technique |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45315 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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