CPT 45402 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 • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45402 |
National average reimbursement for CPT 45402 by major payers:
$1,881.73
$2,030.36
$2,154.43
$2,508.22
| 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 45402 | ||||||
United | 45402 | $1231.00 | 1386748440 - COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY LLC, SHARP SAN DIEGO SURGERY CENTER | 330839637 - (CA) COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $983.00 | 1043303894 - DOCTORS OUTPATIENT SURGERY CENTER OF JUPITER, LLC, LASER & SURGERY CENTER OF THE PALM BEACHES | 650953183 - (FL) DRS. OUTPATIENT SURGERY CENTER OF JUPITER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1200.00 | 1588308035 - BAYSTATE NEW ENGLAND ORTHOPEDIC SURGEONS ALLIANCE, LLC | 881824108 - (MA) BAYSTATE NEW ENGLAND ORTHOPEDIC SURGEONS ALLIANCE LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $249.00 | 1891175188 - PHOENIX SPINE GOODYEAR ASC, LLC, PHOENIX SPINE SURGERY CENTER | 853605981 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $775.00 | 1043426950 - HOSPITAL DRIVE SURGERY CENTER, LLC | 770516196 - (CA) HOSPITAL DRIVE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $2705.00 | 1053803692 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $135.00 | 1184798837 - SHADELANDS ADVANCED ENDOSCOPY INSTITUTE, INC. | 205834466 - (CA) SHADELANDS ADVANCED ENDOSCOPY INSTITUTE INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $105.00 | 1811228083 - MESQUITE SURGERY CENTER LLC | 270170010 - (AZ) MESQUITE SURGERY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $4300.00 | 1649218009 - RIVER DRIVE SURGERY CENTER, LLC, RIVER DRIVE SURGERY AND LASER CENTER | 223672648 - (NJ) RIVER DRIVE SURGERY CENTER L L | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $430.00 | 1215400320 - SURGERY CENTER AT GATEWAY LLC | 823763830 - (MI) SURGERY CENTER AT GATEWAY LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $825.00 | 1750386256 - PALOUSE SURGERY CENTER, LLC | 810593962 - (ID) PALOUSE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $2705.00 | 1619218096 - SAN MARCOS ASC LLC | 800899088 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1000.00 | 1881001212 - AMBULATORY SURGICAL CENTER AT BASKING RIDGE | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $343.00 | 1659360303 - ST JOHNS SURGERY CENTER LLC | 650502027 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $2377.00 | 1104373315 - BRENTWOOD SURGERY CENTER, LLC, BRENTWOOD SURGERY CENTER | 200533890 | TN | 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 45402 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45402 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 45402 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 45402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45402 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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