CPT 46255 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 • 52 - Reduced Services • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $506.87 Physician Fee Schedule |
National average reimbursement for CPT 46255 by major payers:
$611.90
$661.71
$723.57
$833.52
| 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 46255 | ||||||
United | 46255 | $624.00 | 1295403426 - DRS LLC, MCMINNVILLE SURGERY CENTER | 320613056 - (OR) DRS LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1000.00 | 1609206614 - HURST AMBULATORY SURGERY CENTER, LLC, PRECINCT AMBULATORY SURGERY CENTER, LLC | 463648821 - (TX) HURST AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $652.00 | 1366746752 - NEW ENGLAND FERTILITY SURGICAL CENTER | 264741111 - (CT) NEW ENGLAND FERTILITY SURGICAL CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1155.00 | 1972096568 - NUVISION SAME DAY PROCEDURE CENTER LLC | 830820085 - (TX) NUVISION SAME DAY PROCEDURE CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $591.00 | 1477562148 - SANI EYE CENTER, INC., SANI EYE SURGERY CENTER | 953764955 - (CA) SANI EYE CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $2353.00 | 1659625101 - ENDOSCOPY CENTER OF GRAND JUNCTION LLC | 461251610 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $983.00 | 1174850176 - SOUTHWEST OHIO PAIN MANAGEMENT LLC | 300571536 - (OH) SOUTHWEST OHIO PAIN MANAGEMENT | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $5048.00 | 1033586136 - PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC, MEMORIAL HERMANN SURGERY CENTER PARK TEN | 371789833 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1496.00 | 1437320017 - OREGON EYE SURGERY CENTER, INC. | 930973443 - (OR) OREGON EYE SURGERY CENTER INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $900.00 | 1790742328 - SPRINGHILL SURGERY CENTER, LLC | 621712554 - (AR) SPRINGHILL SURGERY CENTER, LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1600.00 | 1982965612 - SKYPARK SURGERY CENTER LLC | 455320930 - (CA) SKYPARK SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1358.00 | 1346240751 - ROSWELL CENTER FOR FOOT & ANKLE SURGERY, LLC | 201549920 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $1000.00 | 1184699241 - SAN LUIS OBISPO CA ENDOSCOPY ASC LP, TEMPLETON ENDOSCOPY CENTER | 201965605 - (CA) SAN LUIS OBISPO CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $886.00 | 1346270428 - BALTIMORE AMBULATORY CENTER FOR ENDOSCOPY | 521913193 - (MD) BALTIMORE AMBULATORY CENTER FO | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46255 | $2717.00 | 1114965803 - ADVANCED ENDOSCOPY & SURGICAL CENTER LLC, ADVANCED ENDOSCOPY & SURGICAL CENTER | 113660090 - (NJ) ADVANCED ENDOSCOPY SURGICAL CENTER LLC | NJ | 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 46255 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46255 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 46255 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) |
| 46250-CPT | Moderate | Hemorrhoidectomy,External,2 Or More Columns Or Groups |
| 46255-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; |
| 46258-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; With Fistulectomy, Including Fissurectomy, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46255 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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