CPT 45550 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 • 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 |
| CMS | $1,408.69 Physician Fee Schedule |
National average reimbursement for CPT 45550 by major payers:
$1,798.07
$1,940.73
$1,994.72
$2,384.59
| 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 45550 | ||||||
United | 45550 | $275.00 | 1770907172 - EYE AND LASER SURGERY CENTERS OF NEW JERSEY LLC | 462875016 - (NJ) EYE AND LASER SURGERY CENTERS OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $1064.00 | 1306575121 - ROCKY MOUNTAIN ENDOSCOPY CENTERS, LLC | 841403147 - (CO) ROCKY MOUNTAIN ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $2500.00 | 1255728499 - SUMMIT ATLANTIC SURGERY CENTER LLC | 473235212 - (NJ) SUMMIT ATLANTIC SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $163.00 | 1497728984 - MOUNT DORA OPHTHALMOLOGY ASC LLC, MID FLORIDA SURGERY CENTER | 621795778 - (FL) MOUNT DORA OPHTHALMOLOGY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $565.00 | 1447661145 - ADVANCED OUTPATIENT SURGERY OF OKLAHOMA, LLC | 371751472 - (OK) ADVANCED OUTPATIENT SURGERY OF | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $670.00 | 1497750426 - NEW ALBANY OUTPATIENT SURGERY, LLC, SURGICAL CENTER OF NEW ALBANY | 232722876 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $624.00 | 1659548329 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $384.00 | 1285678979 - BAY SURGERY CENTERS LLC, CLEARWAY SURGERY CENTER OF ANNAPOLIS | 204934078 - (MD) BAY SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $814.00 | 1881461705 - GLACIER SURGICAL CENTER, LLC | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $1274.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $416.00 | 1447258603 - SNOWDEN RIVER SURGERY CENTER LLC | 200946902 - (MD) SNOWDEN RIVER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $3500.00 | 1619972791 - AMBULATORY SURGERY CENTER OF SPARTANBURG, LLC | 571128350 - (SC) AMBULATORY SURGERY CENTER OF SPARTANBURG | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $2544.00 | 1568094399 - SURGERY CENTER OF SOUTHWEST OHIO, LLC, THE SURGERY CENTER OF SOUTHWEST OHIO | 831673860 - (OH) THE SURGERY CENTER OF SOUTHWEST | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $2730.00 | 1093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC | 371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45550 | $610.00 | 1821560434 - SUNSET PAIN SURGERY CENTER | 832872516 - (NV) SUNSET PAIN SURGERY CENTER | NV | 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 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 |
|---|---|---|
| 45398-CPT | Moderate | Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Band Ligation(S) (Eg, Hemorrhoids) |
| 45402-CPT | High | Proctopexy With Sigmoid Resection |
| 45499-CPT | High | Unlisted Laproscopy Procedure Rectum |
| 45550-CPT | High | Proctopexy W Sigmoid Resect |
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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