CPT 46060 Fee Schedule
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.
| 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 • 78 - Return to OR - related procedure • 58 - Staged or related procedure during postoperative period • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46060 |
National average reimbursement for CPT 46060 by major payers:
$578.64
$621.92
$682.74
$793.43
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 46060 | ||||||
United | 46060 | $404.00 | 1427662345 - BENTONVILLE AMBULATORY SURGERY CENTER, LLC | 832500684 - (AR) BENTONVILLE AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $725.00 | 1003357377 - NEPHROLOGY PHYSICIANS LLC | 352082018 - (IN) NEPHROLOGY PHYSICIANS LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $487.00 | 1215038252 - RED LION SURGICENTER, LLC | 204914143 - (PA) RED LION SURGICENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $2675.00 | 1932146990 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1369.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1250.00 | 1164723011 - SURGICAL SPECIALTY CENTER OF WESTCHESTER LLC, PLASTIC SURGERY CENTER OF WESTCHESTER LLC | 273453889 - (NY) SURGICAL SPECIALTY CENTER OF WESTCHESTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1714.00 | 1942267893 - GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA | 223345724 - (NJ) GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1528.00 | 1477569069 - FISH POND SURGERY CENTER, LLC | 742901471 - (TX) FISH POND SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $514.00 | 1669424339 - ARKANSAS GASTROENTEROLOGY ENDOSCOPY CENTER | 300314945 - (AR) ARKANSAS GASTROENTEROLOGY ENDOSCOPY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $789.00 | 1750668190 - ELKHART DAY SURGERY, LLC, INSIGHT SURGERY CENTER | 800712220 - (IN) ELKHART DAY SURGERY LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $644.00 | 1730687179 - MULTICARE HEALTH SYSTEM, MULTICARE ROCKWOOD EYE SURGERY CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1809.00 | 1144970807 - MEDICAL CITY SURGERY CENTER SOUTHLAKE, LLC | 881391141 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $600.00 | 1912412420 - GALEA CENTER, LLC., GALEA CENTER FOR ADVANCED SURGERY | 821939476 - (CA) GALEA CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $1233.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46060 | $602.00 | 1386739498 - GEORGIA LITHOTRIPSY AND LASER CENTER | 581879891 - (GA) GEORGIA LITHOTRIPSY AND LASER CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 46060 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46060 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 46060 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 |
|---|---|---|
| 46020-CPT | Moderate | Placement Of Seton |
| 46030-CPT | Moderate | Remove Seton/Other Marker Anal |
| 46045-CPT | Moderate | I&D Abscess,Transanal,Under Anesth |
| 46060-CPT | Moderate | Incision And Drainage Of Ischiorectal Or Intramural Abscess, With Fistulectomy Or Fistulotomy, Submuscular, With Or Without Placement Of Seton |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46060. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46060 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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