CPT 45499 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 • 80 - Assistant surgeon • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45499 |
National average reimbursement for CPT 45499 by major payers:
$1,771.31
$3,372.00
$5,124.59
$747.00
| 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 45499 | ||||||
United | 45499 | $1984.00 | 1992034763 - CENTRAL ARKANSAS SURGICAL CENTER, LLC | 270564540 - (AR) CENTRAL ARKANSAS SURGICAL CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1605.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $5083.00 | 1992763932 - HEALTHEAST SURGERY CENTER-MAPLEWOOD, LLC, MAPLEWOOD SURGERY CENTER | 203349887 - (MN) HEALTHEAST SURGERY CENTERMAPLEWOOD LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1947.00 | 1396213294 - UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | 831320776 - (OH) UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2927.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2375.00 | 1770911463 - SALUBRIOUS ASC, LLC | 463866454 - (GA) SALUBRIOUS ASC LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $5354.00 | 1831525112 - LONGLEAF SURGERY CENTER, LLC | 462421622 - (FL) LONGLEAF SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $15000.00 | 1750071007 - DISC SURGERY CENTER AT MARINA DEL REY LLC | 880601479 - (CA) DISC SURGERY CENTER AT MARINA DEL REY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $3506.00 | 1053585125 - BJOSC, LLC, BONE & JOINT SURGERY CENTER | 300391378 - BJOSC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1427.00 | 1669668943 - POOLE ENDOSCOPY CENTER, NEEL KAMAL MD | 521831316 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $586.00 | 1306885256 - EYE SURGICAL CENTER, LLC, THE INSTITUTE FOR REFRACTIVE AND INTRAOCULAR SURGERY | 200318724 - (OH) EYE SURGICAL CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2400.00 | 1437120953 - MONTGOMERY SURGERY CENTER LIMITED PARTNERSHIP | 521401868 - (MD) MONTGOMERY SURGERY CENTER LIMITED PARTNERSHIP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1375.00 | 1265672356 - RIVERSIDE SURGICAL CENTER,LLC | 262228384 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $4244.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $9501.00 | 1477552768 - COURT STREET SURGERY CENTER, LP | 300197423 | CA | 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 45499 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45499 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 45499 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 |
|---|---|---|
| 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 |
| 45399-CPT | Moderate | Other Procedure On Large Bowel |
| 45400-CPT | High | Laparoscopy Surgical Proctopexy |
| 45499-CPT | High | Unlisted Laproscopy Procedure Rectum |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45499 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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