CPT 46258 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 • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46258 |
National average reimbursement for CPT 46258 by major payers:
$590.97
$613.69
$654.83
$778.90
| 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 46258 | ||||||
United | 46258 | $1400.00 | 1790710390 - SOUTHWESTERN MEDICAL CENTER, LLC, MAGNA SURGICAL CENTER | 364212258 - (IL) SOUTHWESTERN MEDICAL CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $8705.00 | 1689053050 - BELTWAY SURGERY CENTERS, LLC, MULTISPECIALTY SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $654.00 | 1093907339 - TAYLOR SURGERY CENTER, LLC, SURGICAL ARTS SURGERY CENTER | 710860395 - (AR) TAYLOR SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $3598.00 | 1083754352 - MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA, MERCY PHILADELPHIA HOSPITAL SHORT PROCEDURE UNIT | 231352191 - (PA) MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1700.00 | 1285936641 - RIVERS EDGE AESTHETIC SURGERY, LLC | 271645468 - (SD) RIVERS EDGE AESTHETIC SURGERY LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $760.00 | 1558733147 - RIVER CITY SURGICAL CENTER | 475369004 - (ID) RIVER CITY SURGICAL CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1769.00 | 1437138500 - CONCORD EYE SURGERY LLC | 20522032 - (NH) CONCORD EYE SURGERY LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2353.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1425.00 | 1225096134 - GAINESVILLE EYE CENTER, LLC | 201895224 - (GA) GAINESVILLE EYE CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2353.00 | 1124125604 - MURDOCK AMBULATORY SURGERY CENTER LLC | 201543128 - (FL) MURDOCK AMBULATORY SURGERY CENTE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $7259.00 | 1154375475 - COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP, MEDICAL CITY NORTH HILLS | 621682205 - (TX) COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $8705.00 | 1306351887 - BELTWAY SURGERY CENTERS, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1155.00 | 1194968677 - PROFESSIONAL SURGICENTER, INC | 330970915 - (CA) PROFESSIONAL SURGICENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2276.00 | 1952540825 - ROME ORTHOPAEDIC CLINIC ASC, INC. | 261595646 - (GA) ROME ORTHOPAEDIC CLINIC ASC INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $700.00 | 1710952882 - ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC | 813253496 | WA | 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 46258 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46258 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 46258 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 46258. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46258 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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