CPT 46261 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 • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $524.01 Physician Fee Schedule |
National average reimbursement for CPT 46261 by major payers:
$660.34
$689.42
$710.24
$872.50
| 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 46261 | ||||||
United | 46261 | $1919.00 | 1295233658 - LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC | 823717201 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1897.00 | 1093352908 - BAPTIST HEALTHCARE SYSTEM, INC., BAPTIST HEALTH SURGERY CENTER EASTPOINT | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $2353.00 | 1235178146 - SUBURBAN ENDOSCOPY CENTER, LLC, SUBURBAN ENDOSCOPY CENTER | 820556996 - (NJ) SUBURBAN ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $2538.00 | 1710060751 - BAY AREA SURGICAL GROUP, INC. | 201198494 - (CA) BAY AREA SURGICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1258.00 | 1881002343 - INNOVATIVE SURGERY CENTER, LLC | 471395981 - (MD) INNOVATIVE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $8705.00 | 1811172729 - INDIANA ENDOSCOPY CENTERS LLC, INDIANA ENDOSCOPY CENTER WEST | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1505.00 | 1104866904 - SOUTHWESTERN EYE CENTER, SOUTHWESTERN EYE SURGICENTER-SHOW LOW | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1155.00 | 1972923068 - TRUECARE SURGERY CENTER, LLC | 463892733 - (CA) TRUECARE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $697.00 | 1275639023 - SURGICAL CENTER OF BURLINGTON COUNTY, INC | 202116181 - (NJ) SURGICAL CENTER OF BURLINGTON COUNTY INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $916.55 | 1710479761 - MOLLIE WETSTEIN | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 46261 | $916.55 | 1922458322 - NAGA SAI SHRAVAN TURAGA | 350593390 - DEACONESS HOSPITAL INC | KY | Cardiovascular Disease Physician (207RC0000X) |
United | 46261 | $1750.00 | 1124026422 - CHARLESTON ENT ASSOCIATES, LLC, SURGERY CENTER OF CHARLESTON | 582281023 - (SC) CHARLESTON ENT ASSOCIATES, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1200.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1479.00 | 1629135843 - NAEEM M AKHTAR, MADERA AMBULATORY ENDOSCOPY CENTER | 770194609 - (CA) NAEEM M. AKHTAR, M.D. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46261 | $1297.00 | 1265435176 - POCONO AMBULATORY SURGERY CENTER LTD | 232611442 - (PA) POCONO AMBULATORY SURGERY CENTER LTD | PA | 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 46261 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46261 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 46261 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; |
| 46258-CPT | Moderate | Hemorrhoidectomy, Internal And External, Single Column/Group; With Fistulectomy, Including Fissurectomy, When Performed |
| 46261-CPT | Moderate | Hemorrhoidectomy Complx W Fissurect |
| 46262-CPT | Moderate | Hemorrhoidectomy, Internal And External, 2 Or More Columns/Groups; 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 46261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46261 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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