CPT 45320 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $213.81 Physician Fee Schedule |
National average reimbursement for CPT 45320 by major payers:
$261.76
$272.04
$299.37
$349.44
| 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 45320 | ||||||
United | 45320 | $1001.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1821.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2564.00 | 1245749258 - FOCUS HAND SURGICENTER LLC, FOCUS HAND AND ARM SURGERY CENTER | 822523843 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $580.00 | 1760440515 - SIERRA ENDOSCOPY CENTER, LLC | 680482297 - (CA) SIERRA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2717.00 | 1942397104 - PREMIER ENDOSCOPY, LLC | 50599351 - (NJ) PREMIER ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2538.00 | 1649500950 - NATIONAL AMBULATORY SURGERY CENTER, LLC | 271343081 - (CA) NATIONAL AMBULATORY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1533.00 | 1629458427 - CLARKSVILLE SURGICENTER, LLC | 473830244 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1100.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2155.00 | 1205869211 - ROANOKE SURGERY CENTER, LP | 61755240 - (VA) ROANOKE SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1500.00 | 1003847500 - WESTSIDE OUTPATIENT CENTER, LLC, PALMS WELLINGTON SURGICAL CENTER | 651078372 - (FL) WESTSIDE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $580.00 | 1174073506 - WILSHIRE ENDOSCOPY CENTER LLC | 813966913 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2859.00 | 1811994080 - PACIFIC ENDO-SURGICAL CENTER, LP, PACIFIC ENDO-SURGICAL CENTER | 562387275 - (CA) PACIFIC ENDOSURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1786.00 | 1740681733 - SURGCENTER OF GREATER PHOENIX, LLC | 465683789 - (AZ) SURGCENTER OF GREATER PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $2263.00 | 1477242154 - PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC, PLYMOUTH ORTHOPEDIC SURGERY CENTER | 883632673 - (MN) PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45320 | $1250.00 | 1124406632 - COMPREHENSIVE PAIN ASC, LLC | 473944400 - (CA) COMPREHENSIVE PAIN ASC LLC | CA | 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 45320 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45320 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 45320 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 |
|---|---|---|
| 45317-CPT | Moderate | Proctosigmoidoscopy, Rigid; With Control Of Bleeding (Eg, Injection, Bipolar Cautery, Unipolar Cautery, Laser, Heater Probe, Stapler, Plasma Coagulator) |
| 45320-CPT | Moderate | Proctosigmoidoscopy, Rigid; With Ablation Of Tumor(S), Polyp(S), Or Other Lesion(S) Not Amenable To Removal By Hot Biopsy Forceps, Bipolar Cautery Or Snare Technique (Eg, Laser) |
| 45321-CPT | Low | Proctosigmoidoscopy; Decompression Volvu |
| 45338-CPT | Moderate | Sigmoidoscopy, Flexible; With Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By 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 45320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45320 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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