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See a sample rate comparisonCPT 45563 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.
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).
| 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 GC - Service performed by resident under supervision 59 - Distinct Procedural Service 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45563 |
| Medicaid Fee Schedule | View Medicaid rates for 45563 |
National average reimbursement for CPT 45563 by major payers:
$2,011.15
$2,182.84
$2,275.77
$2,618.82
Compare published rates across providers.
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CPT 45563
5 of 25 sample ratesHigher to lower in this preview
Peak One Surgery Center, LLC, Peak One Surgery Center
Peak One Surgery Center LLC
$9,210.00Published rateSelect Physicians Surgery Centers
Select Physicians Surgery Center, LLC
$1,064.00Published rateAndrews Institute Asc LLC
Andrews Institute Asc, LLC
$1,028.00Published rateCase Center For Surgery & Endoscopy LLC
Case, LLC
$650.00Published rateDallas Endoscopy Center, Ltd
Dallas Endoscopy Center Ltd
$121.00Published rate
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See a sample payer proposalCPT 45563 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45563 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 45563 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 45563. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45563 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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