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 |
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 | $2346.00 | 1225490196 - OLNEY ENDOSCOPY CENTER | 473544166 - (MD) OLNEY ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2392.00 | 1780618801 - PINEY ORCHARD SURGERY CENTER, LLC. | 521938770 - (MD) PINEY ORCHARD SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $4473.00 | 1124439450 - ALLEGHENY CLINIC, WEXFORD SURGERY CENTER | 251838458 - HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $4839.00 | 1164513149 - ENDO-SURGI OF UNION ASC LLC | 223248249 - (NJ) ENDO-SURGI CENTER, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1850.00 | 1457335077 - DENVER EYE SURGERY CENTER, LLC | 840974806 - (CO) DENVER EYE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $7770.00 | 1497312540 - MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC | 384114079 | TX | 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 | $5354.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $3816.00 | 1235393356 - PHYSICIANS OUTPATIENT SURGERY CENTER LLC | 352325646 - (FL) PHYSICIANS OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $6189.00 | 1275682148 - TEMPLE UNIVERSITY HOSPITAL, INC | 232825878 - (PA) TEMPLE UNIVERSITY HOSPITAL INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $3275.00 | 1386821817 - MIAMI SURGERY CENTER LLC, SURGERY CENTER AT DORAL | 364600281 - (FL) MIAMI SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $4535.00 | 1730500935 - BARDMOOR SURGERY CENTER LLC, BARDMOOR SURGERY CENTER | 204385452 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2276.00 | 1053385328 - MIDWEST ENDOSCOPY SERVICES LLC | 470808172 - (NE) MIDWEST ENDOSCOPY SERVICES, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $1669.00 | 1154986347 - CENTER FOR VISUAL SURGICAL EXCELLENCE, LLC | 820674025 - (VA) CENTER FOR VISUAL SURGICAL EXCELLENCE LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45499 | $2400.00 | 1275542011 - NORTH CRESCENT SURGERY CENTER, L.L.C. | 201764601 - (GA) NORTH CRESCENT SURGERY CENTER LLC | GA | 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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