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 |
| CMS | $1,464.97 Physician Fee Schedule |
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 | $384.00 | 1457784852 - SMART PAIN SURGERY CENTER AT OWINGS MILLS, LLC, CLEARWAY SURGERY CENTER OF OWINGS MILLS | 454995677 - (MD) SMART PAIN SURGERY CENTER AT OWINGS MILLS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1050.00 | 1467491407 - DEARBORN SURGERY CENTER, LLC, DEARBORN SURGERY CENTER | 383494075 - (MI) DEARBORN SURGERY CENTER, LLC | MI | 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 | $520.00 | 1356412894 - ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | 364513047 - (IL) ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $604.00 | 1437801388 - FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | 863588248 - (WI) FRESENIUS ACCESS CARE PHYSICIANS OF MADISON ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $395.00 | 1699711382 - TOWSON SURGICAL CENTER LLC, TOWSON SURGICAL CENTER | 521945958 - (MD) TOWSON SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $200.00 | 1487699385 - MWGI LLC, BRANDYWINE VALLEY ENDOSCOPY CENTER | 593788546 - (PA) MWGI LLC | PA | 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 | $1000.00 | 1881001212 - AMBULATORY SURGICAL CENTER AT BASKING RIDGE | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1407.00 | 1447355243 - SURGICENTER OF GREATER MILWAUKEE, LLC, SURGICENTER OF GREATER MILWAUKEE, INC. | 391682308 - (WI) CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $375.00 | 1144200163 - ABILENE ASC LP, ABILENE ENDOSCOPY CENTER | 621562008 - (TX) ABILENE ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $330.00 | 1609269232 - SURGICAL CENTER OF PONTE VEDRA BEACH LLC, PONTE VEDRA BEACH SURGERY CENTER | 472133947 - (FL) SURGICAL CENTER OF PONTE VEDRA B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1146.00 | 1962938332 - BANNER UNION HILLS SURGERY CENTER LLC | 901164193 - (AZ) BANNER UNION HILLS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $1030.00 | 1598328932 - ENDO GROUP, LLC | 200248148 - (NY) ENDO GROUP LLC DBA GARDEN CITY SURGICENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45402 | $517.00 | 1174520191 - AESTHETIC SURGERY CENTER OF EUGENE INC | 931320547 - (OR) AESTHETIC SURGERY CENTER OF EUGENE INC | OR | 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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