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See a sample rate comparisonCPT 46080 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.
Sphincterotomy,Anal,Divis-Sphincter
| 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 | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46080 |
| Medicaid Fee Schedule | View Medicaid rates for 46080 |
National average reimbursement for CPT 46080 by major payers:
$320.08
$335.04
$379.93
$265.19
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CPT 46080
5 of 25 sample ratesHigher to lower in this preview
Wisconsin Surgery Center LLC
Wisconsin Surgery Center, LLC
$2,739.00Published rateSurgcenter Of Glen Burnie, Surgcenter Of Glen Burnie, LLC
Surgcenter Of Glen Burnie, LLC
$1,258.00Published rateDigestive Endoscopy Center LLC
Digestive Endoscopy Center, LLC
$724.00Published rateEndoscopic Surgical Centre Of Maryland-North LLC, Endoscopic Surgical Centre Of Maryland North
$496.00Published rateSurgery Center At Gateway LLC
$370.00Published rate
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See a sample payer proposalCPT 46080 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46080 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 46080 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 |
|---|---|---|
| 45905-CPT | Moderate | Dilation Of Anal Sphincter (Sepa Proc) Under Anesthe Other, Dilation Of Anal Sphincter (Separate Procedure) Under Anesthesia Other |
| 46070-CPT | Moderate | Inc Anal Septum Infant |
| 46080-CPT | Moderate | Sphincterotomy,Anal,Divis-Sphincter |
| 46083-CPT | Moderate | Inc Thrombosed Hemorrhoid External |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46080. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46080 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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