CPT 45800 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | High |
| CMS | $1,242.75 Physician Fee Schedule |
National average reimbursement for CPT 45800 by major payers:
$1,536.68
$1,650.90
$1,692.32
$2,034.79
| 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 45800 | ||||||
United | 45800 | $624.00 | 1619144607 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $200.00 | 1912547746 - PORT ARTHUR SURGICAL CENTER, LLC, GULF COAST SURGERY CENTER | 843158723 - (TX) PORT ARTHUR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $761.00 | 1396896684 - DREYER AMBULATORY SURGERY CENTER, LLC | 363890298 - (IL) DREYER AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $410.00 | 1235789041 - MAPLESHADE SURGERY CENTER, LLC | 814826814 - (TX) MAPLESHADE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $372.00 | 1033113402 - NORTHWEST FLORIDA SURGICAL CENTER, LLC, NORTH FLORIDA SURGERY CENTER | 593081991 - (FL) NORTHWEST FLORIDA SURGICAL CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $2069.00 | 1114924685 - SOUTH KANSAS CITY SURGICAL CENTER, LC, SOUTH KANSAS CITY SURGICENTER | 202181884 - (KS) SOUTH KANSAS CITY SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $921.00 | 1316949415 - NEWPORT BEACH SURGERY CENTER, LLC, NEWPORT BEACH SURGERY CENTER | 330488134 - (CA) NEWPORT BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $2652.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $390.00 | 1710203427 - HARLINGEN SURGICAL CENTER, LLC, VALLEY EYE SURGERY CENTER | 270561821 - (TX) HARLINGEN SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $650.00 | 1962953018 - THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | 611795393 - (FL) THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $667.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $750.00 | 1659420727 - THE ENDOSCOPY CENTER, INC. | 460450119 - (SD) THE ENDOSCOPY CENTER INC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $900.00 | 1346773421 - WOMEN'S CARE FLORIDA LLC, WOMEN'S CARE FLORIDA SURGICAL CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $2737.00 | 1033448782 - ENDOSCOPY SURGERY CENTER OF SILICON VALLEY LLC | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45800 | $100.00 | 1023015989 - TUCSON GASTROENTEROLOGY INSTITUTE, LLC | 860966257 - (AZ) TUCSON GASTROENTEROLOGY INSTITUTE LLC | AZ | 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 45800 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45800 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 45800 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 |
|---|---|---|
| 45120-CPT | High | Proctectomy, Complete (For Congenital Megacolon), Abdominal And Perineal Approach; With Pull-Through Procedure And Anastomosis (Eg, Swenson, Duhamel, Or Soave Type Operation) |
| 45562-CPT | High | Exploration, Repair, And Presacral Drainage For Rectal Injury |
| 45563-CPT | High | Exploratn, Repair & Presacral Drainage F/Rectal Injury; W/Colostomy |
| 45800-CPT | High | Close Rectovesical Fistula |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45800. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45800 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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