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 |
| Medicare Fee Schedule | View Medicare rates for 45321 |
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 | $580.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1080.00 | 1346698602 - MARION EYE SURGERY CENTER LLC | 263644916 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $606.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $2717.00 | 1609803204 - AFFILIATED ENDOSCOPY SERVICES OF CLIFTON LLC, AFFILIATED ENDOSCOPY SERVICES OF CLIFTON | 270064844 - (NJ) AFFILIATED ENDOSCOPY SERVICES OF CLIFTON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $580.00 | 1912412420 - GALEA CENTER, LLC., GALEA CENTER FOR ADVANCED SURGERY | 821939476 - (CA) GALEA CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1530.00 | 1114057023 - CROSSROADS SURGERY CENTER INC | 205799348 - (MN) CROSSROADS SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1062.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $580.00 | 1750609731 - BELTLINE SURGERY CENTER, LLC | 262639054 - (TX) BELTLINE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1887.00 | 1336268754 - MOUNTAIN VISTA ORTHOPAEDIC SURGERY CENTER, LLC | 710936920 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $550.00 | 1811052749 - GDC ENDOSCOPY CENTER LLC | 651240653 - (GA) GDC ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $81.65 | 1790949592 - SHAUNA FUNDERBURK | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 45321 | $2168.00 | 1447932769 - PRO SURGERY CENTER LLC | 931484998 - (WA) PRO SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $3150.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1035.00 | 1154538544 - COLLIER ENDOSCOPY & SURGERY CENTER | 651093702 - (FL) COLLIER ENDOSCOPY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45321 | $1026.00 | 1639566318 - TRIAD SURGERY CENTER, LLC | 473510624 | OK | 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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