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See a sample rate comparisonCPT 45999 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.
Unlisted Procedure Rectum
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient 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 45999 |
| Medicaid Fee Schedule | View Medicaid rates for 45999 |
National average reimbursement for CPT 45999 by major payers:
$893.56
$99.94
$278.50
$679.36
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CPT 45999
5 of 25 sample ratesHigher to lower in this preview
Summit Orthopedic Surgery Center, LLC, Sosc
Summit Orthopedic Surgery Center LLC
$2,372.00Published rateSouth Georgia Endoscopy Center, Inc
South Georgia Endoscopy Center Inc
$967.00Published rateWestlake Spine & Outpatient Surgery Center
Journey Lite Of The Central Coast LLC
$637.00Published rateLake Mary Surgery Center LLC
Lake Mary Surgery Center
$424.00Published ratePioneer Ambulatory Surgery Center, LLC
Pioneer Ambulatory Surgery Center LLC
$279.00Published rate
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See a sample payer proposalCPT 45999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45999 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 45999 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 |
|---|---|---|
| 45990-CPT | Low | Anorectal Exam Surg Requir Anesthe (Gnral Spinal Or Ep, Anorectal Exam Surgical Requiring Anesthesia (General Spinal Or Ep |
| 45999-CPT | Moderate | Unlisted Procedure Rectum |
| 46020-CPT | Moderate | Rectal Surgery, Surgery To Close Off An Abnormal Passageway (Fistula). This Is A Two-Stage Procedure. First A Type Of Gauze Is Placed In The Rectum To Mark And Surround The Fistula. The Gauze Is Pulled Tight Gradually Until The Fistula Is Closed. |
| 46030-CPT | Moderate | Rectal Surgery, Surgery To Close Off An Abnormal Passageway (Fistula). This Is A Two-Stage Procedure. First A Type Of Gauze Is Placed In The Rectum To Mark And Surround The Fistula. The Gauze Is Pulled Tight Gradually Until The Fistula Is Closed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45999 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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