CPT 46257 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 • SG - Scene to Hospital ESRD facility • 52 - Reduced Services |
| Complexity Level | Moderate |
| CMS | $410.80 Physician Fee Schedule |
National average reimbursement for CPT 46257 by major payers:
$511.29
$553.56
$579.62
$695.69
| 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 46257 | ||||||
United | 46257 | $1700.00 | 1790145480 - TWIN CITIES SURGERY CENTER | 463311193 - (MN) TWIN CITIES SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $2808.00 | 1851407399 - SOUTHERN NEW MEXICO SURGERY CENTER, LLC | 201826172 - (NM) SOUTHERN NEW MEXICO SURGERY CENTER | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $1155.00 | 1164478764 - SURGERY CENTER OF LAWTON PROFESSIONAL LLC | 731579076 - (OK) SURGERY CENTER OF LAWTON PROFESSIONAL LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $1535.00 | 1316191430 - LAREDO DIGESTIVE HEALTH CENTER LLC | 261286495 - (TX) LAREDO DIGESTIVE HEALTH CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $680.00 | 1558339424 - PREMIER SURGERY CENTER | 352206509 - (CA) PREMIPREMIER SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $3150.00 | 1992037352 - BAYLOR SURGICARE AT MANSFIELD, LLC, BAYLOR SCOTT & WHITE SURGICARE - MANSFIELD | 271835675 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $1203.00 | 1740254572 - THE NORTHERN NV ENDOSCOPY ASC LLC, DIGESTIVE HEALTH CENTER | 200470103 - THE NORTHERN NV ENDOSCOPY ASC LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $2015.00 | 1053835983 - GROUP SURGICAL PARTNERS INTEGRATED LLC, LEGENT OUTPATIENT SURGERY - FRISCO | 821249116 - (TX) GROUP SURGICAL PARTNERS INTEGRATED LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $541.00 | 1386602332 - THREE RIVERS ENDOSCOPY CENTER, INC. | 251788887 - (PA) THREE RIVERS ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $1954.00 | 1801944343 - HUDSON VALLEY AMBULATORY SURGERY, LLC | 510451539 - (NY) HUDSON VALLEY AMBULATORY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $680.00 | 1518107937 - ALICIA SURGERY CENTER LLC | 262186548 - (CA) ALICIA SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $2295.29 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $1150.00 | 1093760019 - OCEAN COUNTY EYE ASSOCIATES LLC, OCEAN COUNTY EYE SURGERY CENTER | 223256927 - (NJ) OCEAN COUNTY EYE ASSOCIATES, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $2203.00 | 1346270329 - MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | 200485202 - (VA) MARY IMMACULATE AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46257 | $2173.00 | 1982667499 - CLEAR LAKE SURGICARE, LTD | 621600411 | 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 46257 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46257 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 46257 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 |
|---|---|---|
| 46255-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; |
| 46257-CPT | Moderate | Hemorrhoidectmy,Smpl;W/Fissurectmy |
| 46258-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; With Fistulectomy, Including Fissurectomy, When Performed |
| 46261-CPT | Moderate | Hemorrhoidectomy Complx W Fissurect |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46257. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46257 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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