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 |
| CMS | $476.79 Physician Fee Schedule |
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 | $680.00 | 1982845186 - SUTTER BAY MEDICAL FOUNDATION, PALO ALTO MEDICAL FOUNDATION FOR HEALTH CARE, RESEARCH & EDUCATION | 941156581 - SUTTER BAY MEDICAL FOUNDATION | CA | 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 | $1632.00 | 1558053868 - LORAIN AMHERST SURGERY CENTER LLC | 853470191 - (OH) LORAIN AMHERST SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2353.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1155.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | 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 | $3828.00 | 1386028439 - JOHNSTON MEMORIAL HOSPITAL, INC, JOHNSTON MEMORIAL SURGERY CENTER | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1513.00 | 1982677191 - LAS VEGAS EAST OPHTHALMOLOGY ASC LLC, SHEPHERD EYE SURGICENTER | 752829740 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1198.00 | 1447385158 - HARBIN CLINIC, LLC, HARBIN GI | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2363.00 | 1700838471 - SANTA CRUZ SURGERY CENTER | 770194916 - (CA) SANTA CRUZ SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1293.00 | 1629094917 - ANNAPOLIS ENT SURGICAL CENTER, LLC | 522337616 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1685.00 | 1316350275 - ORCHARD SURGICAL CENTER, LLC, ORCHARD SURGICAL CENTER | 465568612 - (NH) ORCHARD SURGICAL CENTER, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $2859.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $1148.00 | 1982105458 - HEART CARE CENTER, LLC | 824195385 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46258 | $680.00 | 1689699597 - NAPA SURGERY CENTER LLC | 680366295 - (CA) NAPA SURGERY CENTER 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 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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