CPT 46288 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 • 58 - Staged or related procedure during postoperative period • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46288 |
National average reimbursement for CPT 46288 by major payers:
$692.84
$717.61
$772.64
$912.50
| 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 46288 | ||||||
United | 46288 | $3632.00 | 1144948167 - MCALLEN SURGICENTER, LLC, MCALLEN SURGERY CENTER | 862290088 - (TX) MCALLEN SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1099.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1176.00 | 1790786218 - FORT WASHINGTON SURGERY CENTER, LLC, THE SURGERY CENTER AT FORT WASHINGTON | 731594870 - (PA) FOUNDATION SURGERY AFFILIATES OF FORT WASHINGTON, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1410.00 | 1255604534 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC TUCSON | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $5124.00 | 1962626523 - CALLOWAY CREEK SURGERY CENTER LP | 141948102 - (TX) CALLOWAY CREEK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $3067.00 | 1508818634 - MONTEREY BAY ENDOSCOPY CENTER LLC | 770324855 - (CA) MONTEREY BAY ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1882.00 | 1497314181 - OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC | 832118109 - (IL) OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1085.00 | 1093778052 - MIDWEST EYE CONSULTANTS, P.C., CLI SURGERY CENTER | 351845786 - (IN) MIDWEST EYE CONSULTANTS, P.C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $3165.00 | 1255339628 - BISMARCK SURGICAL ASSOCIATES, LLC | 450450254 - (ND) BISMARCK SURGICAL ASSOCIATES LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $1635.00 | 1396203238 - SUN CITY CENTER AMBULATORY SURGERY CENTER, LLC, SUN CITY ASC | 832043435 - (FL) SUN CITY CENTER AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $2148.00 | 1366884322 - INNOVATIONS SURGERY CENTER, PC | 461513141 - (MD) INNOVATIONS SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $2263.00 | 1063878734 - CESC, LLC | 811020132 | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $2380.00 | 1538146931 - WILLAMETTE SURGERY CENTER LLC | 260018738 - (OR) WILLAMETTE SURGERY CENTER, P.C. | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $2100.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46288 | $2200.00 | 1588267546 - BINGHAMTON ASC LLC, GREATER BINGHAMTON EYE SURGERY CENTER | 833672662 - (NY) BINGHAMTON ASC LLC | NY | 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 46288 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46288 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 46288 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46288. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46288 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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