CPT 46604 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 | • 11 - Office • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46604 |
National average reimbursement for CPT 46604 by major payers:
$678.17
$782.46
$895.83
$1,029.22
| 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 46604 | ||||||
United | 46604 | $565.00 | 1841711942 - MACON VASCULAR CARE, LLC | 320415161 - (GA) MACON VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $515.09 | 1801076120 - STEFANIE LANGENBERG | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
United | 46604 | $614.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $875.00 | 1356798854 - MID CITIES ASC, LP | 811663790 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1179.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $559.00 | 1801869847 - AESCULAPIAN SURGERY CENTER, LLC, INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CENTER | 920179499 - (FL) AESCULAPIAN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1725.00 | 1750553376 - SAN MATEO SURGERY CENTER LLC | 510655329 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1050.00 | 1952912552 - SURGERY CENTER OF NORTH CENTRAL OHIO LLC, THE SURGERY CENTER OF NORTH CENTRAL OHIO | 833986181 - (OH) THE SURGERY CENTER OF NORTH CENT | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $575.00 | 1689608697 - ADVANCED COLON CARE INC, SHORELINE COLONOSCOPY SUITES | 61562707 - (CT) ADVANCED COLON CARE INC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $336.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 30527649 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1749.00 | 1730876210 - MEDICAL CITY SURGERY CENTER NORTH TEXAS, LLC | 923326615 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1258.00 | 1629559208 - ORTHOARIZONA SURGERY CENTER GILBERT, LLC, ORTHOARIZONA SURGERY CENTER GILBERT | 823624585 - (AZ) ORTHOARIZONA SURGERY CENTER GILBERT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1651.00 | 1780935528 - QUEENS ENDOSCOPY ASC, LLC | 274189294 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1121.07 | 1205821691 - ELLA VARNEY | 350593390 - DEACONESS HOSPITAL INC | FL | Hospitalist Physician (208M00000X) |
United | 46604 | $353.00 | 1598700676 - FLORIDA EYE INSTITUTE SURGICENTER LLC | 134232690 - (FL) FLORIDA EYE INSTITUTE SURGICENTER LLC | FL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 46604 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46604 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 46604 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 |
|---|---|---|
| 46600-CPT | Low | Anoscopy; Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Desc Revised 01/01/15) |
| 46604-CPT | Moderate | Anoscopy W Dilation Direct |
| 46606-CPT | Moderate | Anoscopy; For Biopsy |
| 46607-CPT | Moderate | Anoscopy, Diagnostic With High-Resolution Magnification (Hra) (Eg, Colposcope, Operating Microscope) And Chemical Agent Enhancement, With Biopsy, Single Or Multiple |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46604 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 46604) and we'll show you how you compare in 15 minutes or less.