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See a sample rate comparisonCPT 45540 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.
Repair Rectum Out Of Anus, Surgery To Repair Rectal Prolapse (Condition Where Rectum Falls Out Of Place And Presses On Anus Wall).
| 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 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45540 |
| Medicaid Fee Schedule | View Medicaid rates for 45540 |
National average reimbursement for CPT 45540 by major payers:
$1,288.05
$1,404.59
$1,476.47
$1,691.49
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CPT 45540
5 of 25 sample ratesHigher to lower in this preview
Pavilion Surgicenter, LLC, Physicians Pavilion Surgery Center
$2,732.00Published rateMurdock Ambulatory Surgery Center LLC
Murdock Ambulatory Surgery Cente
$1,049.00Published rateSan Gabriel Ambulatory Surgery Center, Lp
San Gabriel Ambulatory Surgery Center Lp
$665.00Published rateKuresmart Pain Management Surgery Center-Catonsville LLC, Clearway Surgery Center Of Catonsville
Kuresmart Pain Management Surgery Centercatonsville LLC
$384.00Published rateRf Eye PC, Cochise Eye & Laser Asc
R.F. Eye, PC
$100.00Published rate
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See a sample payer proposalCPT 45540 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45540 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 45540 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 |
| 45505-CPT | Moderate | Proctoplasty Prolapse Mucous Membr |
| 45540-CPT | High | Repair Rectum Out Of Anus, Surgery To Repair Rectal Prolapse (Condition Where Rectum Falls Out Of Place And Presses On Anus Wall). |
| 45541-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 45540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45540 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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