CPT 45391 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 • 51 - Multiple procedures • 33 - Preventive Services |
| Complexity Level | Moderate |
| CMS | $246.16 Physician Fee Schedule |
National average reimbursement for CPT 45391 by major payers:
$360.50
$366.17
$390.68
$453.40
| 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 45391 | ||||||
United | 45391 | $1586.00 | 1023182086 - EAST TEXAS MEDICAL CENTER CARTHAGE, ETMC CARTHAGE | 824005981 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $941.00 | 1952540825 - ROME ORTHOPAEDIC CLINIC ASC, INC. | 261595646 - (GA) ROME ORTHOPAEDIC CLINIC ASC INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $2382.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $1179.00 | 1104485440 - SURGCENTER OF GREATER JACKSONVILLE, LLC | 832504492 - (FL) SURGCENTER OF GREATER JACKSONVILLE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $1629.00 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $600.00 | 1417080342 - MORGANTON EYE PHYSICIANS, P.A., EYE SURGERY CENTER OF SHELBY | 561109834 - (NC) MORGANTON EYE PHYSICIANS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $2403.00 | 1730834730 - HERITAGE DEVELOPMENT PARTNERS, LLC, ORTHOPAEDIC SURGERY CENTER | 882720151 - (KY) HERITAGE DEVELOPMENT PARTNERS LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $691.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $1461.00 | 1558053868 - LORAIN AMHERST SURGERY CENTER LLC | 853470191 - (OH) LORAIN AMHERST SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $2358.00 | 1790721769 - SAN FRANCISCO SURGERY CENTER, LP | 870689493 - (CA) SAN FRANCISCO SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $928.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $575.00 | 1508404922 - ORTHO CENTRAL | 843880872 - (OK) ORTHO CENTRAL | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $461.00 | 1093368151 - DESERT PEAKS SURGERY CENTER LLC | 842431154 - (NM) DESERT PEAKS SURGERY CENTER LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $1910.00 | 1528016789 - HAMILTON SURGERY CENTER L.L.C., SURGER CENTER AT HAMILTON | 830358914 - (NJ) HAMILTON SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45391 | $362.00 | 1942353115 - SOUTHERN CRESCENT PLASTIC SURGERY ASC | 582093063 | GA | 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 45391 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45391 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 45391 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 |
|---|---|---|
| 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 |
| 45382-CPT | Moderate | Colonoscopy Flexible With Control Of Bleeding Any Method (Desc Revised 01/01/15) Cautery Unipolar Cautery Laser Heater Probe Stapler Plasma Coagulator) |
| 45391-CPT | Moderate | Colonoscopy Flexible With Endoscopic Ultrasound Examination Limited To The Rectum Sigmoid Descending Transverse Or Ascending Colon And Cecum And Adjacent Structures (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 45391. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45391 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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