CPT 45820 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 |
| Common Modifiers | • None • 62 - Co-Surgeons • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45820 |
National average reimbursement for CPT 45820 by major payers:
$1,551.60
$1,641.23
$1,723.67
$2,025.98
| 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 45820 | ||||||
United | 45820 | $405.00 | 1801869292 - AMSURG NORTHERN KENTUCKY GI LLC, ST. ELIZABETH PHYSICIANS ENDOSCOPY CENTER | 621719097 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $1124.00 | 1023604931 - ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | 854282481 - (AZ) ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $990.00 | 1154624526 - THE AMBULATORY SURGERY CENTER AT ST. MARY, LLC | 272871206 - (PA) AMBULATORY SURGICAL CENTER AT ST. MARY'S | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $624.00 | 1467629147 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $775.00 | 1134779622 - HELIX SURGICENTER LLC | 834455797 - (IN) HELIX SURGICENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $840.00 | 1538124490 - CITRUS REGIONAL SURGERY CENTER LP | 621510209 - (FL) CITRUS REGIONAL SURGERY CENTER LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $200.00 | 1205925278 - LUDWICK LASER & SURGERY CENTER, LLC | 205159711 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $639.00 | 1932782315 - WAKE SPINE AND SPECIALTY SURGERY CENTER LLC, RALEIGH NEUROSURGICAL AND SPINE SURGERY CENTER | 842694789 - (NC) WAKE SPINE & SPECIALTY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $1064.00 | 1235395385 - TENN SM LLC | 680569923 - (TN) TENN SM LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $1274.00 | 1306263983 - GCSA AMBULATORY SURGERY CENTER, LLC, GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO NE | 611699459 - (TX) GCSA AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $2732.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $477.00 | 1194803320 - ORANGE COUNTY OPHTHALMOLOGY MEDICAL GROUP, ORANGE COUNTY EYE SURGICAL CENTER | 953520142 - (CA) ROBERT H. COLLIER, MD, INC. ET AL, PTR. ORANGE COUNTY OPHTHALMOLOGY ME | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $600.00 | 1154839678 - R&R SURGICAL INSTITUTE | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $1064.00 | 1770180986 - AUDUBON AMBULATORY SURGERY CENTER LLC, AUDUBON ASC AT ST. FRANCIS | 841482638 - (CO) AUDUBON AMBULATORY SURGERY CENTER, LLC. | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 45820 | $544.00 | 1467016055 - HARBIN CLINIC, LLC, HARBIN CLINIC GI LAB CARTERSVILLE | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | 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 45820 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45820 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 45820 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45820 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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