CPT 45540 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 • 59 - Distinct Procedural Service |
| Complexity Level | High |
| CMS | $1,018.59 Physician Fee Schedule |
National average reimbursement for CPT 45540 by major payers:
$1,288.05
$1,404.59
$1,476.47
$1,728.71
| 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 45540 | ||||||
United | 45540 | $3983.00 | 1407116361 - MONTEREY PENINSULA SURGERY CENTER CAPITOLA, CAPITOLA SURGERY CENTER | 770470910 - (CA) MONTEREY PENINSULA SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $936.00 | 1598083594 - MID-STATE ENDOSCOPY CENTER LLC | 270673692 - (TN) MIDSTATE ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $150.00 | 1487171575 - AMERICAN ACCESS CARE OF RICHMOND ASC LLC, AZURA SURGERY CENTER RIVER CITY | 814550552 - (VA) AMERICAN ACCESS CARE OF RICHMOND ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $1457.00 | 1922639426 - ASSOCIATED HEALTH SERVICES, INC., ARRINGDON AMBULATORY SURGERY CENTER | 561845329 - (NC) ASSOCIATED HEALTH SERVICES INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $438.00 | 1366496143 - VIRGINIA SURGERY CENTER, LLC, CVP SURGERY CENTER | 541922041 - (VA) VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $983.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $1274.00 | 1194935577 - MILLENNIUM SURGICAL CENTER LLC | 205225327 - (NJ) MILLENNIUM SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $132.00 | 1336143148 - MARIN OPHTHALMIC SURGERY CENTER | 680297790 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $1217.00 | 1306556907 - THE VANCOUVER CLINIC INC PS, SALMON CREEK 2 AMBULATORY SURGERY CENTER | 910851599 - THE VANCOUVER CLINIC, INC., PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $300.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $802.00 | 1689669418 - DIAGNOSTIC ENDOSCOPY LLC | 223750394 - (CT) DIAGNOSTIC ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $793.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $1234.00 | 1407169212 - GEORGIA SPINE SURGERY CENTER, LLC, GNS SURGERY CENTER | 271111856 - (GA) GEORGIA SPINE SURGERY CENTER, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $100.00 | 1588665269 - RF EYE PC, COCHISE EYE & LASER ASC | 860879991 - (AZ) R.F. EYE, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45540 | $1050.00 | 1962506618 - THE POLYCLINIC, ASC POLYCLINIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | 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 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 | 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 |
| 45499-CPT | High | Unlisted Laproscopy Procedure Rectum |
| 45505-CPT | Moderate | Proctoplasty Prolapse Mucous Membr |
| 45540-CPT | High | Proctopexy Abd Prolapse |
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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