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See a sample rate comparisonCPT 45550 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 24 - Ambulatory Surgical Center |
| Common Modifiers | None 80 - Assistant surgeon GC - Service performed by resident under supervision AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45550 |
| Medicaid Fee Schedule | View Medicaid rates for 45550 |
National average reimbursement for CPT 45550 by major payers:
$1,798.07
$1,940.73
$1,994.72
$2,333.05
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CPT 45550
5 of 25 sample ratesHigher to lower in this preview
Delaware Surgery Center, LLC
$4,300.00Published rateSurgical Center Of Connecticut LLC
Surgical Center Of Connecticut
$1,215.00Published ratePacific Northwest Surgery Center LLC
$734.00Published rateAdvanced Endoscopy Center LLC
$556.00Published ratePalestine Laser & Surgery Center PLLC
Palestine Laser Surgery Center PLLC
$112.00Published rate
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See a sample payer proposalCPT 45550 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45550 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 45550 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 |
|---|---|---|
| 45402-CPT | High | Laparoscopy Surg; Proctopexy (For Prolapse) W/ Sigmoid Resecti, Laparoscopy Surgical; Proctopexy (For Prolapse) With Sigmoid Resecti |
| 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). |
| 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 45550. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45550 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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