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 |
| Medicare Fee Schedule | View Medicare rates for 45393 |
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 | $1276.00 | 1184125809 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | 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 | 45393 | $1567.00 | 1174587984 - ST MARKS AMBULATORY SURGERY ASSOCIATES LP, MT. OLYMPUS SURGERY CENTER | 621449273 - (UT) ST MARKS AMBULATORY SURGERY ASSOCIATES LP | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1073.00 | 1740681733 - SURGCENTER OF GREATER PHOENIX, LLC | 465683789 - (AZ) SURGCENTER OF GREATER PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $747.00 | 1821285073 - GLENDORA CA ENDOSCOPY ASC LP, GLENDORA DIGESTIVE DISEASE INSTITUTE | 205732678 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $920.00 | 1275938102 - FOURTH CORNER NEUROSURGICAL ASSOCIATES INC PS, CASCADE OUTPATIENT SPINE CENTER | 911416044 - (WA) FOURTH CORNER NEUROSURGICAL ASSOCIATES, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $598.00 | 1114312659 - UNITED SHOCKWAVE SERVICES, LTD., UNITED THERAPIES | 363415474 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1000.00 | 1538664644 - TAMPA BAY SURGERY CENTER ASSOCIATES LTD, CENTER FOR ADVANCED SURGICAL SPECIALIST | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1500.00 | 1518057546 - LONG ISLAND AMBULATORY SURGERY CENTER, LLC | 200369668 - (NY) LONG ISLAND AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $1146.00 | 1477886406 - BILTMORE SURGICAL PARTNERS, LLC, DEER VALLEY SURGICAL AND ENDOSCOPY CENTER | 264509307 - (AZ) BILTMORE SURGICAL PARTNERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $989.00 | 1366449910 - OREGON ENDOSCOPY CENTER, LLC | 931311609 - (OR) OREGON ENDOSCOPY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $450.00 | 1710924881 - GEORGIA DERMASURGERY CENTERS, INC. | 582495671 - (GA) GEORGIA DERMASURGERY CENTERS INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $961.00 | 1982211728 - FT SCOTT SURGERY CENTER LLC | 853127325 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $600.00 | 1184689408 - EVERGREEN EYE CENTER, PLLC, EYE ASSOCIATES NORTHWEST SURGERY CENTER | 911610832 - (WA) EYE ASSOCIATES NORTHWEST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45393 | $700.00 | 1255792453 - MIDWEST EYE CONSULTANTS OHIO, INC, CATARACT & LASER INSTITUTE #351 | 300888250 - (OH) MIDWEST EYE CONSULTANTS OHIO INC | OH | 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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