CPT 46221 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 | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $278.83 Physician Fee Schedule |
National average reimbursement for CPT 46221 by major payers:
$324.60
$341.71
$384.62
$452.82
| 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 46221 | ||||||
United | 46221 | $520.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $767.00 | 1346205481 - BLOOMINGTON EYE INSTITUTE LLC | 371361486 - (IL) BLOOMINGTON EYE INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $1155.00 | 1760794218 - NSC MANAGEMENT COMPANY, INC., ENDEAVOR SURGICAL CENTER | 954683164 - (CA) NORTHRIDGE SURGERY AND PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $1886.00 | 1982680492 - ROCKLAND SURGICAL PROJECT, LLC, RAMAPO VALLEY SURGICAL CENTER | 200580403 - (NJ) ROCKLAND SURGICAL PROJECT LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $523.00 | 1275507527 - ENDOSCOPY CENTER OF NORTHWEST CONNECTICUT | 61609993 - (CT) ENDOSCOPY CENTER OF NORTHWEST CT | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $285.00 | 1871644823 - PERLOW FACILITY, LLC | 251926011 - (GA) PERLOW FACILITY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $1367.00 | 1285870303 - LAPORTE MEDICAL GROUP SURGICAL CENTER, LLC | 260505795 - (IN) LAPORTE MEDICAL GROUP SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $1158.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $392.00 | 1740491422 - PV PENINSULA PLASTIC SURGERY CENTER | 208545497 - (CA) PV PENINSULA PLASTIC SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $913.00 | 1831117704 - MEDICAL HEIGHTS SURGERY CENTER, INC., KENTUCKY SURGERY CENTER | 843280181 - (KY) BAPTIST HEALTH SURGERY CENTER, L | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $667.00 | 1114584786 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $525.00 | 1285333914 - ARIZONA SURGICAL SPECIALISTS CENTER, LLC, ARIZONA SURGICAL SPECIALISTS CENTER, LLC - SCOTTSDALE | 760737449 - (AZ) ARIZONA SURGICAL SPECIALISTS CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $4215.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $1155.00 | 1497201867 - ABILENE CENTER FOR ORTHOPEDIC AND MULTISPECIALTY SURGERY, L.L.C. | 813619502 - (TX) ABILENE CENTER FOR ORTHOPEDIC AND MULTISPECIALTY SURGERY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46221 | $384.00 | 1629045133 - MONTICELLO COMMUNITY SURGERY CENTER, LLC, UVA HEALTH SURGICAL CARE RIVERSIDE | 113656095 - (VA) MONTICELLO COMMUNITY SURGERY | VA | 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 46221 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46221 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 46221 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 |
|---|---|---|
| 46220-CPT | Moderate | Removal Of Single External Benign Growth (Papilla Or Tag) Of Anus |
| 46221-CPT | Moderate | Hemorrhoidectomy, Internal, By Rubber Band Ligation(S) |
| 46230-CPT | Moderate | Removal Of Multiple External Benign Growths (Papillas Or Tags) Of Anus |
| 46250-CPT | Moderate | Hemorrhoidectomy,External,2 Or More Columns Or Groups |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46221. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46221 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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