CPT 46275 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 • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46275 |
National average reimbursement for CPT 46275 by major payers:
$653.57
$692.53
$771.71
$894.16
| 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 46275 | ||||||
United | 46275 | $876.28 | 1104918879 - JOHN DAVIS | 461045337 - (LA) PARADIGM HEALTH SYSTEM | LA | Orthopaedic Surgery Physician (207X00000X) |
United | 46275 | $1397.00 | 1740491422 - PV PENINSULA PLASTIC SURGERY CENTER | 208545497 - (CA) PV PENINSULA PLASTIC SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $1155.00 | 1124498357 - ENDOSCOPY CENTER OF INLAND EMPIRE LLC | 474733900 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $1370.00 | 1255397964 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $2252.25 | 1073149365 - MEDFORD SURGERY CENTER LLC | 384079196 - (MA) MEDFORD SURGERY CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $770.00 | 1609026533 - EYE SURGICENTER LLC | 651005108 - (FL) EYE SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $3144.43 | 1649748708 - ANKENY MEDICAL PARK SURGERY CENTER LC | 831281114 - (IA) ANKENY MEDICAL PARK SURGERY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $800.00 | 1851491013 - NEW ENGLAND AMBULATORY SURGICENTER, LLC | 205110715 - (MA) NEW ENGLAND AMBULATORY SURGICENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $2307.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 843623972 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $5633.25 | 1114976263 - SLIDELL MEMORIAL HOSPITAL, MD IMAGING SLIDELL | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 46275 | $1600.00 | 1043660442 - GEORGIA INTERVENTIONAL PAIN | 812790376 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $2371.00 | 1124137054 - ASCENSION SETON, ASCENSION SETON NORTHWEST | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 46275 | $2531.00 | 1972874907 - CAPITAL CITY SURGERY CENTER, LLC | 260804803 - (NC) CAPITAL CITY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $922.00 | 1356421853 - PINEHURST MEDICAL CLINIC INC, PINEHURST MEDICAL CLINIC ENDOSCOPY CENTER | 560942980 - (NC) PINEHURST MEDICAL CLINIC, INC. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46275 | $3335.00 | 1326004110 - GROSSMONT SURGERY CENTER LP | 330749339 - (CA) GROSSMONT SURGERY CENTER LP | 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 46275 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46275 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 46275 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 |
|---|---|---|
| 46270-CPT | Moderate | Fistulectomy Anal Subq |
| 46275-CPT | Moderate | Surgical Treatment Of Anal Fistula (Fistulectomy/Fistulotomy); Intersphincteric |
| 46280-CPT | Moderate | Surgical Treatment Of Anal Fistula (Fistulectomy/Fistulotomy); Transsphincteric, Supraphincteric, Extrasphincteric Or Multiple, Cluding Placement Of Seton, When Performed |
| 46288-CPT | Moderate | Closure Of Anal Fistula With Rectal Advancement Flap |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46275 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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