CPT 45321 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 | • 21 - Inpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 33 - Preventive Services • 22 - Increased Procedural Services • 51 - Multiple procedures |
| Complexity Level | Low |
| CMS | $101.57 Physician Fee Schedule |
National average reimbursement for CPT 45321 by major payers:
$144.48
$137.05
$143.24
$169.53
| 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 45321 | ||||||
United | 45321 | $1530.00 | 1114057023 - CROSSROADS SURGERY CENTER INC | 205799348 - (MN) CROSSROADS SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1196.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $609.00 | 1164697009 - BOX HILL SURGERY CENTER LLC | 262454678 - (MD) BOX HILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $3473.00 | 1710114293 - RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | 263910345 - (PA) RIVERVIEW SURGERY CENTER AT THE NAVY YARD LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1418.00 | 1134157225 - OCEAN SPRINGS SURGICAL AND ENDOSCOPY CENTER LLC, OCEAN SPRINGS SURGICAL AND ENDOSCOPY CENTER | 640922411 - (MS) OCEAN SPRINGS SURGICAL & ENDOSCOPY CENTER | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $2101.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $918.00 | 1043204688 - INDIANA AMBULATORY SURGICAL ASSOCIATES, INC | 232923182 - (PA) INDIANA AMBULATORY SURGICAL ASSOCIATES INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1167.00 | 1649218009 - RIVER DRIVE SURGERY CENTER, LLC, RIVER DRIVE SURGERY AND LASER CENTER | 223672648 - (NJ) RIVER DRIVE SURGERY CENTER L L | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1121.00 | 1629038989 - SAN ANTONIO EYE CENTER, PA, SAN ANTONIO EYE SURGICENTER | 741916103 - (TX) SAN ANTONIO EYE CENTER, PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $864.00 | 1083124366 - KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER, KPS AMBULATORY SURGERY CENTER | 823254465 - (KY) KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1475.00 | 1992702443 - THE EASTSIDE ENDOSCOPY CENTER LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $600.00 | 1992941462 - NORTHWEST ENDOSCOPY CENTER, LLC, NORTH WEST ENDOSCOPY CENTER | 364644974 - (GA) NORTHWEST ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $4457.00 | 1972254233 - HACKENSACK MUSCULOSKELETAL SURGERY CENTER, LLC | 853437054 - (NJ) HACKENSACK MUSCULOSKELETAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $691.00 | 1093757379 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1887.00 | 1336268754 - MOUNTAIN VISTA ORTHOPAEDIC SURGERY CENTER, LLC | 710936920 | CO | 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 45321 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45321 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 45321 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 |
|---|---|---|
| 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 |
| 45335-CPT | Moderate | Sigmoidoscopy, Flexible; With Directed Submucosal Injection(S), Any Substance |
| 45337-CPT | Low | Sigmoidoscopy Flexible; With Decompression Of (For Pathologic Distention)(Eg Volvulus Megacolon) Including Placement Of Decompression Tube When Performed (Desc Revised 01/01/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45321. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45321 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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