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See a sample rate comparisonHealthcare providers use this code to document and receive reimbursement for visits that address moderate-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 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 45915 |
| Medicaid Fee Schedule | View Medicaid rates for 45915 |
National average reimbursement for CPT 45915 by major payers:

$408.65

$438.54

$491.79

$375.17
Choose a payer to see a sample of rates for CPT 45915.
Peak One Surgery Center LLC
Coral Ridge Outpatient Center, LLC
Heart Of Texas Surgery Center PLLC
Deaconess Hospital Inc
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 45915 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45915 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 45915 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). |
| 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). |
| 45905-CPT | Moderate | Dilation Of Anal Sphincter (Sepa Proc) Under Anesthe Other, Dilation Of Anal Sphincter (Separate Procedure) Under Anesthesia Other |
| 45915-CPT | Moderate | Remval Of Fecal Impaction Or Foreign Body (Sepa Proc) Under, Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45915. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45915 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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