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See a sample rate comparisonCPT 45820 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.
Close Rectoureth Fistula
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 45820 |
National average reimbursement for CPT 45820 by major payers:
$1,551.60
$1,641.23
$1,723.67
$1,983.20
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CPT 45820
5 of 25 sample ratesHigher to lower in this preview
Surgery Center, LLC
The Surgery Center, LLC
$16,236.00Published rateTenn Sm LLC
$1,064.00Published rateAdvanced Orthopaedic Surgery Center, LLC, Las Vegas Institute For Advanced Surgery
Advanced Orthopaedic Surgery Center LLC
$775.00Published rateHarbin Clinic, LLC, Harbin Clinic Gi Lab Cartersville
The Harbin Clinic, L.L.C.
$544.00Published rateBlue Ash Endoscopy Center, LLC
$125.00Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 45805-CPT | High | Repair Rectum/Bladder Passage, Surgery To Repair An Abnormal Passageway (Fistula) Between The Rectum And The Bladder. The Procedure Includes Creating A Connection Between A Portion Of The Colon And A Surgically Created Opening In The Abdominal Wall (Stoma). |
| 45820-CPT | High | Close Rectoureth Fistula |
| 45825-CPT | High | Repair Rectum/Urethra Passage, Surgery To Repair An Abnormal Passageway (Fistula) Between The Rectum And The Urethra. The Procedure Includes Creating A Connection Between A Portion Of The Colon And A Surgically Created Opening In The Abdominal Wall (Stoma). |
| 45900-CPT | Moderate | Repair Rectum That Slips Down, Procedure To Correct Rectal Prolapse (Condition Where The Walls Of The Rectum Fall Out Of Place And Protrude From The Anus). |
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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