CPT 45342 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 • AG - Primary physician • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45342 |
National average reimbursement for CPT 45342 by major payers:
$240.96
$261.76
$264.72
$309.15
| 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 45342 | ||||||
United | 45342 | $350.00 | 1396454963 - ST LUKES SURGICAL CENTER INC, ST. LUKE'S SURGICAL AT WESLEY CHAPEL | 592407224 - (FL) ST LUKES SURGICAL CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $544.00 | 1235255605 - EAGLE EYE SURGERY AND LASER CENTER LLC, EAGLE EYE SURGERY & LASER CENTER | 820521864 - (ID) EAGLE EYE SURGERY AND LASER CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $611.00 | 1336605351 - KURESMART PAIN MANAGEMENT SURGERY CENTER, CLEARWAY SURGERY CENTER OF DUNDALK | 832407319 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $717.00 | 1710151063 - HENDI AMBULATORY SURGERY CENTER, PC | 262238944 - (MD) HENDI AMBULATORY SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $825.00 | 1710127774 - NORTHERN CALIFORNIA ADVANCED SURGERY CENTER LP | 264264927 - (CA) NORTHERN CALIFORNIA ADVANCED SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $525.00 | 1831165331 - SPOKANE EYE CLINIC INC, PS, SPOKANE EYE SURGERY CENTER | 910852217 - (WA) SPOKANE EYE CLINIC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $644.00 | 1699054098 - SURGCENTER OF WESTERN MARYLAND, LLC | 272969860 - (MD) SURGCENTER OF WESTERN MARYLAND, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $775.00 | 1922625995 - NATIONAL SURGICAL CENTERS STOCKTON, LLC | 842979070 - (CA) NATIONAL SURGICAL CENTERS STOCKT | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $694.00 | 1548785116 - NEPHROLOGY & INTERNAL MEDICINE, INC., NEPHROLOGY & INTERNAL MEDICINE INC | 351298573 - (IN) NEPHROLOGY & INTERNAL MEDICINE, INC. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $1182.00 | 1538316278 - PHYSICIANS' SURGERY CENTER OF DOWNEY, LLC | 205170962 - (CA) PHYSICIANS SURGERY CENTER OF | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $2347.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $750.00 | 1801811443 - PHYSICIANS OF WINTER HAVEN LLC, DAY SURGERY CENTER | 200324393 - (FL) PHYSICIANS OF WINTER HAVEN, LLC DBA DAY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $450.00 | 1710924881 - GEORGIA DERMASURGERY CENTERS, INC. | 582495671 - (GA) GEORGIA DERMASURGERY CENTERS INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $353.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45342 | $524.00 | 1760414056 - VAN DYCK ASC, LLC | 621817203 - (TN) VAN DYCK ASC LLC | TN | 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 45342 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45342 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 45342 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 |
|---|---|---|
| 45342-CPT | Moderate | Sigmoidoscopy, Flexible; With Transendoscopic Ultrasound Guided Intramural Or Transmural Fine Needle Aspiration/Biopsy(S) |
| 45347-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed With Placement Of Endoscopic Stent Includes Pre And Post-Dilat |
| 45350-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Band Ligations(S) (Eg, Hemorrhoids). |
| 45389-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed, With Endoscopic Stent Placement Includes Pre And Post Dilation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45342 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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