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See a sample rate comparisonCPT 45397 Fee Schedule
Last Verified: October 2026
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.
Lap Remove Rectum W Pouch, 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
| 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 22 - Increased Procedural Services AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45397 |
| Medicaid Fee Schedule | View Medicaid rates for 45397 |
National average reimbursement for CPT 45397 by major payers:
$2,711.32
$2,852.32
$3,063.20
$3,442.49
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CPT 45397
5 of 25 sample ratesHigher to lower in this preview
Pain Care Of North Texas
$3,022.00Published rateAmbulatory Center For Endoscopy, LLC
$1,145.00Published rateNew England Laser And Cosmetic Surgery Center LLC
$936.00Published rateDigestive Disease & Endoscopy Center, LLC, Digestive Disease & Endoscopy Center, PLLC
Digestive Disease & Endoscopy Center, PLLC
$465.00Published rateRiverlakes Surgery Center LLC
$110.00Published rate
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See a sample payer proposalCPT 45397 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45397 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 45397 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 |
|---|---|---|
| 45395-CPT | High | Rectum Removal With Scope, Surgery Aided By A Scope (Laparoscope) To Remove The Rectum. An Opening Into The Intestine Is Created For Collection Of Waste In A Pouch Worn Outside The Body (Colostomy). |
| 45397-CPT | High | Lap Remove Rectum W Pouch, 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 |
| 45402-CPT | High | Laparoscopy Surg; Proctopexy (For Prolapse) W/ Sigmoid Resecti, Laparoscopy Surgical; Proctopexy (For Prolapse) With Sigmoid Resecti |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45397. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45397 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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