CPT 46230 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $302.76 Physician Fee Schedule |
National average reimbursement for CPT 46230 by major payers:
$335.59
$367.12
$414.29
$492.01
| 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 46230 | ||||||
United | 46230 | $394.00 | 1649325713 - LIBERTY EYE SURGICAL CENTER, LIBERTY SURGICAL CENTER | 200054137 - (PA) LIBERTY EYE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $700.00 | 1952363368 - GOLDEN TRIANGLE SURGICENTER LP | 330529450 - (CA) GOLDEN TRIANGLE SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $803.00 | 1407227358 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH SURGERY CENTER AT NORTHPOINT | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $794.00 | 1063459451 - CARROLL COUNTY AMBULATORY SURGICAL CENTER | 522165022 - (MD) CARROLL COUNTY AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $928.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $404.00 | 1346878303 - HOT SPRINGS AMBULATORY SURGERY CENTER, LLC | 832533389 - (AR) HOT SPRINGS AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $578.00 | 1942884457 - CVI AMBULATORY SURGERY CENTER LLC | 844815499 - (FL) CVI AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $494.14 | 1063649101 - SIMEON ZOU | 350593390 - DEACONESS HOSPITAL INC | IN | Neurology Physician (2084N0400X) |
United | 46230 | $1258.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $1258.00 | 1649515354 - SURGCENTER NORTHEAST LLC | 455554995 - (FL) SURGCENTER NORTHEAST, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $439.00 | 1881684538 - MCPEAK SURGERY CENTER LLC | 611310261 - (KY) MCPEAK SURGERY CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $1650.00 | 1457385668 - RAVINE WAY SURGERY CENTER, LLC | 201245279 - (IL) RAVINE WAY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $669.00 | 1083384432 - NASHVILLE SURGICENTER, LLC | 474086590 - (TN) NASHVILLE SURGICENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $1050.00 | 1780747394 - MORRIS AVENUE ENDOSCOPY LLC | 223651957 - (NJ) MORRIS AVENUE ENDOSCOPY, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46230 | $2782.00 | 1235797630 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | 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 46230 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46230 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 46230 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 46230. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46230 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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