CPT 45398 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 33 - Preventive Services • PT - Colorectal cancer screening test; converted to diagnostic test or other procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45398 |
National average reimbursement for CPT 45398 by major payers:
$901.19
$1,020.86
$1,030.12
$1,441.83
| 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 45398 | ||||||
United | 45398 | $545.59 | 1043272768 - PETER WEIGEL | 463778277 | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $1155.15 | 1104897370 - SHANTHI SUBBIAH | 454203973 - (NJ) INSPIRA HEALTH CONNECTONS PC | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $652.46 | 1891741344 - SURENDER RASTOGI | 1891741344 - (NJ) SURENDER RASTOGI | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $1583.00 | 1447219290 - HARSHA OZA | 853737205 | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $579.34 | 1710955174 - ARTHUR SAKOWITZ | 222273328 - (NJ) PULMONARY MEDICINE ASSOCIATES PA | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $1583.00 | 1699782474 - DOANTRANG DU | 454832340 | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $657.29 | 1336264282 - MADHAVI ANNAVAJJULA | 562284741 - (NJ) URGENT CARE MEDICAL ASSOCIATES PROFESSIONAL CORPORATION | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $2581.91 | 1245286178 - CARLOS CESAR | 270444414 - (NJ) GARDEN STATE HEALTHCARE ASSOCIATES, LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $240.52 | 1851371983 - DONNA DIBRUNO | 20701782 - ATLANTICARE PHYSICIAN GROUP PA | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $831.73 | 1497024863 - CHAN NYEIN | 811200310 - (NJ) CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $760.19 | 1457365660 - JEFFREY LEDERMAN | 200547132 - (NJ) MONMOUTH FAMILY HEALTH CENTER INC | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $793.34 | 1629761069 - FIRST HEALTH OF MONROE, PC | 880629534 - (NJ) FIRST HEALTH OF MONROE PC | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $606.25 | 1326087032 - JIMMIE YOUNG | 222192716 - (NJ) CAMCARE HEALTH CORP | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $480.86 | 1376598136 - YELENA BIRGER | 320505032 - (NJ) YELENA BIRGER DO PC | NJ | Internal Medicine Physician (207R00000X) |
United | 45398 | $1583.00 | 1891884482 - WILLIAM CHRISTIANA | 853737205 | NJ | Internal Medicine Physician (207R00000X) |
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 45398 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45398 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 45398 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 |
|---|---|---|
| 45350-CPT | Moderate | Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed With Band Ligations(S) (Eg, Hemorrhoids). |
| 45378-CPT | Moderate | Colonoscopy Flexible Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed (Separate Procedure) (Desc Revised 01/01/15) |
| 45398-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Band Ligation(S) (Eg, Hemorrhoids) |
| 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 45398. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45398 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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