CPT 45331 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 |
| Medicare Fee Schedule | View Medicare rates for 45331 |
National average reimbursement for CPT 45331 by major payers:
$284.05
$308.23
$359.42
$428.89
| 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 45331 | ||||||
United | 45331 | $187.02 | 1982798294 - RAFEUL HUDA | 68607379 | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $433.70 | 1376886663 - JOHN WILKINSON | 721460193 - (LA) BATON ROUGE ORTHOPAEDIC CLINIC, LLC | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 45331 | $930.00 | 1750838801 - MEMORIAL HOUSTON SURGERY CENTER, LLC, MEMORIAL HOUSTON SURGERY CENTER | 371782795 - (TX) MEMORIAL HOUSTON SURGERY CENTER, | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45331 | $920.00 | 1912090432 - MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC | 812557673 - (DC) MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE LLC | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45331 | $625.10 | 1972997989 - HARINDER BAWA | 141981653 - (NJ) HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - PRIMARY CARE PC | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $580.00 | 1629041157 - THE WESTLAKE OPHTHALMOLOGY ASC, LLC, WESTLAKE EYE SURGERY CENTER | 621748633 - (CA) THE WESTLAKE OPHTHALMOLOGY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45331 | $300.39 | 1396770012 - STEPHEN HEINRICH | 720423889 - (LA) THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 45331 | $178.05 | 1407859705 - ARTHUR CABALES | 223784627 - (NJ) MIDLAND MEDICAL ASSOCIATES LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $169.55 | 1487771705 - DONNA MEDICAL CLONIC | 223875437 - (TX) DONNA MEDICAL CLINIC, P.A. | TX | General Acute Care Hospital (282N00000X) |
United | 45331 | $279.79 | 1144307166 - LAFAYETTE MEDICAL CENTER, LLC | 223690621 - (NJ) LAFAYETTE MEDICAL CENTER, LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $279.47 | 1346567146 - JOSEPH BONVILLAIN | 383176457 | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 45331 | $193.55 | 1487227179 - JAKE GURLAND, M.D. | 863883124 - (NJ) JAKE GURLAND MD | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $193.55 | 1912938671 - ALEXANDER KUDRYK | 221656055 - (NJ) LITTLE HILL FOUNDATION FOR THE REHABILITATION OF ALCOHOLICS INC | NJ | Internal Medicine Physician (207R00000X) |
United | 45331 | $915.00 | 1316949415 - NEWPORT BEACH SURGERY CENTER, LLC, NEWPORT BEACH SURGERY CENTER | 330488134 - (CA) NEWPORT BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45331 | $620.34 | 1023540440 - CARMEN SHULMAN | 237155946 - (NJ) RUTGERS HEALTHRWJ PRIMARY MEDICINE GROUP | NJ | Internal Medicine Physician (207R00000X) |
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 45331 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45331 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 45331 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 |
|---|---|---|
| 45330-CPT | Low | Sigmoidoscopy Flexible; Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) (Desc Revised 01/01/15) |
| 45331-CPT | Moderate | Sigmoidoscopy; Biopsy Collect Speciment |
| 45338-CPT | Moderate | Sigmoidoscopy, Flexible; With Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique |
| 45341-CPT | Low | Sigmoidoscopy, Flexible; With Endoscopic Ultrasound Examination |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45331. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45331 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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