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 |
| CMS | $592.26 Physician Fee Schedule |
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 | $1233.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $747.00 | 1013980317 - LOS ANGELES-INGLEWOOD ENDOSCOPY LP, AIRPORT ENDOSCOPY CENTER | 621814135 - (CA) LOS ANGELESINGLEWOOD ENDOSCOPY LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $458.00 | 1023343720 - HATTIESBURG SURGERY CENTER, LLC | 263789784 - (MS) HATTIESBURG SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $531.00 | 1124492996 - MOHS AND SKIN SURGERY CENTER, LLC | 474284353 - (MD) MOHS AND SKIN SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $900.00 | 1275510141 - NEOSPINE PUYALLUP SPINE CENTER, LLC, MICROSURGICAL SPINE CENTER | 203395071 - (WA) NEOSPINE PUYALLUP SPINE CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $3908.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $789.00 | 1750668190 - ELKHART DAY SURGERY, LLC, INSIGHT SURGERY CENTER | 800712220 - (IN) ELKHART DAY SURGERY LLC | IN | 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 | $336.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 30527649 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1260.00 | 1629603162 - NATICK SURGERY CENTER, LLC | 832569075 - (MA) NATICK SURGERY CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $1258.00 | 1881969269 - SURGERY CENTRE OF SW FLORIDA LLC, CAPE HEALTH SURGERY CENTER | 454068750 | 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 | $487.00 | 1740448711 - TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | 262420083 - (PA) TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $2085.00 | 1801892724 - APPLE HILL SURGICAL CENTER PARTNERS, APPLE HILL SURGICAL CENTER | 232489452 - (PA) APPLE HILL SURGICAL CENTER PARTNERS | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46604 | $420.00 | 1033106612 - PSHS ALPHA PARTNERS LLC, LAKE WORTH SURGICAL CENTER | 650793962 - (FL) PSHS ALPHA PARTNERS 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 |
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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.
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