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See a sample rate comparisonCPT 45499 Fee Schedule
Last Verified: October 2026
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.
Unlisted Laproscopy Procedure Rectum
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 45499 |
National average reimbursement for CPT 45499 by major payers:
$1,771.31
$3,372.00
$5,124.59
$16,003.27
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CPT 45499
5 of 25 sample ratesHigher to lower in this preview
Disc Surgery Center At Marina Del Rey LLC
$15,000.00Published rateWayne Surgical Center LLC
Wayne Surgical Center, LLC
$4,244.00Published rateSan Antonio Tx Endoscopy Asc Lp, San Antonio Gastroenterology Endoscopy Center - Med Center
San Antonio Tx Endoscopy Asc Lp
$2,813.00Published rateDenver Eye Surgery Center, LLC
Denver Eye Surgery Center LLC
$1,850.00Published rateEye Surgical Center, LLC, The Institute For Refractive And Intraocular Surgery
Eye Surgical Center LLC
$586.00Published rate
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See a sample payer proposalCPT 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 | Lap Remove Rectum W Pouch, 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 | Surgery Or Exam On Colon, A Procedure Performed On The Colon. |
| 45499-CPT | High | Unlisted Laproscopy Procedure Rectum |
| 45562-CPT | High | Exploration, Repair, And Presacral Drainage For Rectal Injury |
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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