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See a sample rate comparisonCPT 45500 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Proctoplasty Stenosis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | None 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45500 |
| Medicaid Fee Schedule | View Medicaid rates for 45500 |
National average reimbursement for CPT 45500 by major payers:
$726.74
$720.78
$761.75
$911.75
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CPT 45500
5 of 25 sample ratesHigher to lower in this preview
Physicians West Houston Surgical Center, LLC, Memorial Hermann Surgery Center Park Ten
$5,729.00Published rateManchester Surgery Center, LLC
$2,353.00Published rateWatauga Surgical Partners PLLC
$1,700.00Published rateSurgeyecare, Inc., Surgeyecare General Partnership
$1,092.00Published rateOcean Endosurgery Center LLC, Ocean Endosurgery Center
Ocean Endosurgery Center LLC
$721.00Published rate
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See a sample payer proposalCPT 45500 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45500 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 45500 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 |
|---|---|---|
| 45499-CPT | High | Unlisted Laproscopy Procedure Rectum |
| 45500-CPT | Moderate | Proctoplasty Stenosis |
| 45505-CPT | Moderate | Proctoplasty Prolapse Mucous Membr |
| 45550-CPT | High | Repair Rectum Out Of Anus, Surgery To Repair Rectal Prolapse (Condition Where Rectum Falls Out Of Place And Presses On Anus Wall). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45500 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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