CPT 45395 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 22 - Increased Procedural Services |
| Complexity Level | High |
| CMS | $1,885.80 Physician Fee Schedule |
National average reimbursement for CPT 45395 by major payers:
$2,475.70
$2,627.31
$2,797.16
$3,245.19
| 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 45395 | ||||||
United | 45395 | $475.00 | 1700282852 - LAKE JACKSON ENDOSCOPY CENTER, LP. | 800513571 - (TX) LAKE JACKSON ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $2737.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $6489.00 | 1558501916 - ST. FRANCIS MOORESVILLE SURGERY CENTER, LLC | 202256900 - (IN) ST. FRANCIS MOORESVILLE SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $775.00 | 1841955358 - ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR, LLC | 852814304 - (MD) ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $681.00 | 1295897106 - WESTMONT SURGERY CENTER LLC, SALT CREEK SURGERY CENTER | 364419691 - WESTMONT SURGERY CENTER, LLC DBA SALT CREEK SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $571.00 | 1053031237 - FRESENIUS VASCULAR CARE EL PASO ASC LLC | 861628275 - (TX) FRESENIUS VASCULAR CARE EL PASO ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $662.00 | 1730843830 - VOLUSIA ASC BZ, LLC, ADVANCED HEART AND VASCULAR SURGERY CENTER AT DELTONA | 851554243 - (FL) VOLUSIA ASC BZ, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $100.00 | 1164871075 - CENTRAL ARIZONA GI & LIVER INSTITUTE LLC | 812583508 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $479.00 | 1083144653 - GREATER PITTSBURGH SURGERY LLC | 821512721 - (PA) GREATER PITTSBURGH SURGERY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $417.00 | 1033734728 - ORANGE COUNTY SURGICAL CENTER | 851774434 - (CA) ORANGE COUNTY SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $2721.00 | 1932465887 - COLUMBUS SPECIALTY SURGERY CENTER LLC | 454115316 - (IN) COLUMBUS SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $445.00 | 1841954054 - SOUTHERN PLAINS MEDICAL CENTER SPMC-ASC, SPMC-ASC | 872964092 - (OK) SOUTHERN PLAINS MEDICAL CENTER SPMCASC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $412.00 | 1558328518 - BUTLER AMBULATORY SURGERY CENTER L L C | 61728190 - (PA) BUTLER AMBULATORY SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $1299.00 | 1083785398 - OLYMPIA ORTHOPAEDIC ASSOCIATES PLLC, OLYMPIA SURGERY CENTER LLC | 911674528 - OLYMPIA ORTHOPAEDIC ASSOCIATES, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45395 | $703.00 | 1578221479 - SKIN CANCER AND LASER SURGERY CENTER LLC | 854119523 - (IN) SKIN CANCER AND LASER SURGERY CENTER LLC | IN | 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 45395 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45395 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 45395 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 |
|---|---|---|
| 45381-CPT | Moderate | Colonoscopy, Flexible, Proximal To Splenic Flexure; With Directed Submucosal Injection(S), Any Substance |
| 45395-CPT | High | Laparoscopy Surgical Proctectomy Complete Combined Abdominoperneal With Colostomy |
| 45397-CPT | High | Laparoscopy, Surgical; Proctectomy, Combined Abdominoperineal Pull-Through Procedure (Eg, Colo-Anal Anastomosis), With Creation Of Colonic Reservoir (Eg, J-Pouch), With Diverting Enterostomy, When Performed |
| 45400-CPT | High | Laparoscopy Surgical Proctopexy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45395. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45395 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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