CPT 45393 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 • 52 - Reduced Services • 53 - Discontinued procedure |
| Complexity Level | Moderate |
| CMS | $240.01 Physician Fee Schedule |
National average reimbursement for CPT 45393 by major payers:
$346.09
$355.88
$385.25
$448.36
| 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 45393 | ||||||
United | 45393 | $764.00 | 1285120352 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $900.00 | 1225123227 - COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | 770533953 - (CA) COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $470.00 | 1780658245 - ROGERS AR OPHTHALMOLOGY ASC LLC, BOOZMAN-HOF EYE SURGERY & LASER CENTER | 753069680 - (AR) ROGERS AR OPHTHALMOLOGY ASC LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1258.00 | 1750565594 - PEDIATRIC SURGERY CENTER -ODESSA, LLC | 651274446 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $530.00 | 1336324045 - MCCANDLESS ENDOSCOPY CENTER, LLC | 261284448 - (PA) MCCANDLESS ENDOSCOPY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1528.00 | 1992796742 - SAN ANTONIO ENDOSCOPY, LP, SAN ANTONIO ENDOSCOPY CENTER | 202511329 - (TX) SAN ANTONIO ENDOSCOPY LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $780.00 | 1407327356 - ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC, SURGERY CENTER OF BEVERLY HILLS LLC | 832822673 - (CA) ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1367.00 | 1326094491 - PROLIANCE SURGEONS INC PS, PROLIANCE CENTER FOR SPECIALTY SURGERY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $961.00 | 1982211728 - FT SCOTT SURGERY CENTER LLC | 853127325 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $604.00 | 1215302906 - RADIUS SURGERY CENTER LLC | 474627643 - (GA) RADIUS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $565.00 | 1972156842 - NORMAN REGIONAL HOSPITAL AUTHORITY, MEDICAL PLAZA ENDOSCOPY | 736048282 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $3009.00 | 1841858024 - VANGUARD ASC, LLC, VANGUARD SURGICAL CENTER | 352661529 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $758.00 | 1932430816 - SURGCENTER OF GREENBELT, LLC | 270408064 - (MD) SURGCENTER OF GREENBELT LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $839.00 | 1497752745 - ORTHOPEDIC SOUTH SURGICAL PARTNERS, LLC, ORTHOPAEDIC SOUTH SURGICAL CENTER | 260008898 - (GA) ORTHOPEDIC SOUTH SURGICAL PARTNERS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $2480.00 | 1033586136 - PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC, MEMORIAL HERMANN SURGERY CENTER PARK TEN | 371789833 | TX | 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 45393 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45393 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 45393 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 |
|---|---|---|
| 45321-CPT | Low | Proctosigmoidoscopy; Decompression Volvu |
| 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) |
| 45349-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Endoscopic Mucosal Resection. |
| 45393-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimens By Brushing Or Washing, When Performed, With Decompression For Pathologic Distension Eg, Volvulus, Me |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45393. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45393 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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