CPT 46930 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 |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46930 |
National average reimbursement for CPT 46930 by major payers:
$238.55
$279.87
$292.30
$368.13
| 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 46930 | ||||||
United | 46930 | $1753.00 | 1821141284 - CENTER FOR HEALTH AMBULATORY SURGERY CENTER, LLC | 205557171 - (IL) CENTER FOR HEALTH AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $169.66 | 1245695592 - LISA SCHELLER | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 46930 | $850.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $367.00 | 1255604534 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC TUCSON | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $180.00 | 1750568838 - VIVERE HEALTH DALLAS, LLC, VIVERE-DALLAS SURGERY CENTER | 364701304 - (TX) VIVERE HEALTH DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $1626.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $490.00 | 1316924632 - CAROLINA BONE & JOINT SURGERY CENTER | 134241163 - (SC) CAROLINA BONE & JOINT SURGERY | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $470.00 | 1831165331 - SPOKANE EYE CLINIC INC, PS, SPOKANE EYE SURGERY CENTER | 910852217 - (WA) SPOKANE EYE CLINIC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $369.27 | 1972541183 - CHARLES STRICKLAND | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 46930 | $161.00 | 1679566228 - AMBULATORY FOOT AND ANKLE CENTER, INC. | 521910756 - (MD) AMBULATORY FOOT AND ANKLE CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $953.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $463.00 | 1871169136 - WICHITA FALLS SPECIALTY ASC LLC, MOMENTUM SPECIALTY SURGERY CENTER | 842950505 - (TX) WICHITA FALLS SPECIALTY ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $305.00 | 1669954707 - CARDIOVASCULAR SURGICAL SUITES LLC | 831614285 - (FL) CARDIOVASCULAR SURGICAL SUITES L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $587.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46930 | $967.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | 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 46930 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46930 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 46930 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 |
|---|---|---|
| 46900-CPT | Moderate | Destruction Lesion(S), Anus, Simple; Che |
| 46922-CPT | Moderate | Destruction Of Lesion(S), Anus (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Surgical Excision |
| 46930-CPT | Moderate | Destruction Of Internal Hemorrhoids By Thermal Energy Eg Infrared Coagulation Cautery Radiofrequency |
| 46940-CPT | Moderate | Curet/Caut-Anal Fissure,Dilat;Init |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46930. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46930 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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