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See a sample rate comparisonCPT 45825 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.
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).
| 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 22 - Increased Procedural Services AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45825 |
| Medicaid Fee Schedule | View Medicaid rates for 45825 |
National average reimbursement for CPT 45825 by major payers:
$1,898.07
$1,987.59
$2,069.22
$2,400.75
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CPT 45825
5 of 25 sample ratesHigher to lower in this preview
Palms West Surgery Center Ltd
$2,732.00Published rateKips Bay Endoscopy Center, LLC
Kips Bay Endoscopy Center LLC
$1,310.00Published rateOrthoarizona Surgery Center Gilbert, LLC, Orthoarizona Surgery Center Gilbert
Orthoarizona Surgery Center Gilbert LLC
$1,049.00Published rateAsc Development Company LLC
$565.00Published rateFlorida Specialty Surgery Center LLC
$340.00Published rate
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See a sample payer proposalCPT 45825 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45825 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 45825 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 45825. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45825 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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