CPT 45397 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 • 22 - Increased Procedural Services • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| CMS | $2,044.30 Physician Fee Schedule |
National average reimbursement for CPT 45397 by major payers:
$2,711.32
$2,852.32
$3,063.20
$3,522.47
| 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 45397 | ||||||
United | 45397 | $828.00 | 1922526961 - BLAINE ASC, LLC, BLAINE ORTHOPEDIC SURGERY CENTER | 822416401 - (MN) BLAINE ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $258.00 | 1871052712 - KURESMART PAIN MANAGEMENT SURGERY CENTER-COLUMBIA LLC, CLEARWAY SURGERY CENTER OF COLUMBIA | 834028893 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCOLUMBIA LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $110.00 | 1659609311 - RIVERLAKES SURGERY CENTER LLC | 270493977 - (CA) RIVERLAKES SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $150.00 | 1487171575 - AMERICAN ACCESS CARE OF RICHMOND ASC LLC, AZURA SURGERY CENTER RIVER CITY | 814550552 - (VA) AMERICAN ACCESS CARE OF RICHMOND ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $825.00 | 1831139955 - ABINGTON SURGICAL CENTER | 232561054 - (PA) ABINGTON SURGICAL CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $544.00 | 1902960206 - SINUS SURGERY CENTER IDAHO PA | 205282962 - (ID) SINUS SURGERY CENTER IDAHO PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $983.00 | 1366444929 - EAST WEST SURGERY CENTER LP | 621797897 - (GA) EAST WEST SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $2377.00 | 1629458427 - CLARKSVILLE SURGICENTER, LLC | 473830244 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $475.00 | 1275199978 - RAC SURGERY CENTER LLC | 831302565 - (NC) RAC SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $1200.00 | 1780218305 - THE UNIVERSITY OF TEXAS AT AUSTIN, UT HEALTH AUSTIN AMBULATORY SURGERY CENTER | 746000203 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $3022.00 | 1457682841 - PAIN CARE OF NORTH TEXAS | 200081985 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $707.00 | 1518338052 - CENTER FOR ADVANCED SURGERY LLC | 464112873 - (SC) CENTER FOR ADVANCED SURGERY, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $649.00 | 1407188659 - LIMESTONE SURGERY CENTER LLC | 271490855 - (GA) LIMESTONE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $1049.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45397 | $2347.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | 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 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 | 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 |
| 45402-CPT | High | Proctopexy With Sigmoid Resection |
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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