CPT 46250 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 • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46250 |
National average reimbursement for CPT 46250 by major payers:
$567.89
$600.68
$655.92
$761.60
| 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 46250 | ||||||
United | 46250 | $520.00 | 1356798854 - MID CITIES ASC, LP | 811663790 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $520.00 | 1558857177 - MIDLAND AMBULATORY SURGERY CENTER, LLC, ANAND CHOLIA MBR | 825037025 - (TX) MIDLAND AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $520.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $520.00 | 1477502979 - INLAND EAR NOSE AND THROAT A MEDICAL GROUP INC, FOOTHILL AMBULATORY SURGERY CENTER | 953300822 - (CA) M.M. KANOK, M.D., A MEDICAL CORPORA | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $1200.00 | 1457335077 - DENVER EYE SURGERY CENTER, LLC | 840974806 - (CO) DENVER EYE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $1272.00 | 1629166624 - AMBULATORY SURGICAL CENTER OF SOUTHERN NEVADA LLC | 861081788 - (NV) AMBULATORY SURGICAL CENTER OF SOUTHERN NEVADA LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $2087.00 | 1710688627 - BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | 922359229 - (KY) BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $1403.00 | 1649925801 - MUSIC CITY SURGERY CENTER, LLC | 872654999 - (TN) MUSIC CITY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $520.00 | 1528339447 - CP SURGERY CENTER, LLC | 800776412 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $1207.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 200671644 - (ID) PREMIER SURGICAL CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $2380.00 | 1588628358 - OKLAHOMA OUTPATIENT SURGERY LIMITED PARTNERSHIP | 731295678 - (OK) OKLAHOMA OUTPATIENT SURGERY LIMITED PARTNERSHIP | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $375.33 | 1063101368 - OLIVIA CODY | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 46250 | $1950.00 | 1588092605 - GOLD COAST SURGERY CENTER, CENTER FOR SPECIALIZED SURGERY OF SANTA BARBARA | 460639888 - GOLD COAST SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $580.00 | 1780658062 - GLEN ENDOSCOPY CENTER, LLC | 364486546 - (IL) THE GLEN ENDOSCOPY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46250 | $520.00 | 1730378498 - TORRANCE CA MULTISPECIALTY ASC LLC, SURGERY CENTER OF SOUTH BAY | 204259636 - (CA) TORRANCE CA MULTISPECIALTY ASC LLC | CA | 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 46250 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46250 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 46250 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 |
|---|---|---|
| 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 |
| 46255-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46250 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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