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See a sample rate comparisonCPT 45560 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.
Repair Rectum Bulge To Vagina, Surgery To Repair A Rectocele. This Is A Condition Where Tissue From The Wall Of The Rectum Bulges Into The Vagina.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45560 |
| Medicaid Fee Schedule | View Medicaid rates for 45560 |
National average reimbursement for CPT 45560 by major payers:
$841.16
$924.34
$943.48
$1,117.23
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CPT 45560
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Kenai
$8,259.00Published rateMenomonee Falls Ambulatory Surgery Center, LLC
Menomonee Falls Ambulatory Surgery Center
$2,877.00Published rateAdventhealth Surgery Center Innovation Tower, LLC
Adventhealth Surgery Center Innovation Tower LLC
$2,071.00Published rateMuhammad Habib
Deaconess Hospital Inc
$1,220.89Published rateWest Central Surgical Center, LLC
West Central Surgical Center LLC
$680.00Published rate
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See a sample payer proposalCPT 45560 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45560 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 45560 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 |
|---|---|---|
| 45520-CPT | Low | Repair Rectum Out Of Anus, Surgery To Repair Rectal Prolapse (Condition Where Rectum Falls Out Of Place And Presses On Anus Wall). |
| 45560-CPT | Moderate | Repair Rectum Bulge To Vagina, Surgery To Repair A Rectocele. This Is A Condition Where Tissue From The Wall Of The Rectum Bulges Into The Vagina. |
| 45562-CPT | High | Exploration, Repair, And Presacral Drainage For Rectal Injury |
| 45563-CPT | High | Rectal Injury Repair, Surgery To Explore And Repair Injury To Rectum. The Procedure Includes Creating A Connection Between A Portion Of The Colon And A Surgically Created Opening In The Abdominal Wall (Stoma). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45560. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45560 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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