Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 45990 Fee Schedule
Last Verified: October 2026
Healthcare 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.
Anorectal Exam Surg Requir Anesthe (Gnral Spinal Or Ep, Anorectal Exam Surgical Requiring Anesthesia (General Spinal Or Ep
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 45990 |
| Medicaid Fee Schedule | View Medicaid rates for 45990 |
National average reimbursement for CPT 45990 by major payers:
$139.12
$142.98
$153.50
$183.86
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 45990.
CPT 45990
5 of 25 sample ratesHigher to lower in this preview
Waverley Surgery Center LLC, Waverley Surgery Center
Waverley Surgery Center, L.P.
$2,429.00Published rateSt Augustine Endoscopy Center LLC
$1,276.00Published rateCobblestone Surgery Center, Inc.
Cobblestone Surgery Center Inc
$725.00Published rateFillmore Eye Clinic Incorporated, Fillmore Eye Clinic Asc
Fillmore Eye Clinic, Inc.
$582.00Published rateNorthshore Ambulatory Surgery Center LLC
$434.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 45990 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45990 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 45990 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 |
| 45990-CPT | Low | Anorectal Exam Surg Requir Anesthe (Gnral Spinal Or Ep, Anorectal Exam Surgical Requiring Anesthesia (General Spinal Or Ep |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45990. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45990 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 45990) and we'll show you how you compare in 15 minutes or less.