CPT 46940 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46940 |
National average reimbursement for CPT 46940 by major payers:
$302.91
$304.91
$346.99
$415.05
| 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 46940 | ||||||
United | 46940 | $654.00 | 1114990231 - SURGERY CENTER OF MIDDLE TENNESSEE LLC, THE SURGERY CENTER OF MIDDLE TENNESSEE | 621839266 - (TN) SURGERY CENTER OF MIDDLE TENNESSEE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1917.00 | 1487136412 - ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC, ENDOSCOPY CENTER OF SOUTH SACRAMENTO | 364904884 - (CA) ENDOSCOPY CENTER OF SOUTH SACRAMENTO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1181.00 | 1427282771 - UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER LLC, UPSTATE ORTHOPEDICS ASC | 770711020 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $400.00 | 1558844183 - MIDDLEBURG SURGERY CENTER LLC | 831229418 - (FL) MIDDLEBURG SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1207.00 | 1124125331 - AMBULATORY SURGERY ASSOCIATES, LLC, BROOKSIDE SURGERY CENTER | 383237596 - (MI) AMBULATORY SURGERY ASSOCIATES | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $700.00 | 1083114995 - SURGERY CENTER OF LAWRENCEVILLE | 823510956 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $600.00 | 1679025449 - DIGESTIVE HEALTH COMPLEX | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $329.00 | 1891951885 - MISSISSIPPI EYE SURGERY CENTER, MISSISSIPPI EYE SURGERY CENTER FACILITY | 770619942 | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1928.00 | 1316395270 - IRVINE SURGICAL PARTNERS LLC | 812776218 - (CA) IRVINE SURGICAL PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1094.00 | 1124526306 - INDIANA PAIN CENTERS-EVANSVILLE LLC | 823643604 - (IN) INDIANA PAIN CENTERSEVANSVILLE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $401.00 | 1821093204 - LAUREL LASER & SURGERY CENTER, L.P. | 251852464 - (PA) LAUREL LASER SURGERY CENTER LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $565.00 | 1942458062 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $1528.00 | 1295246981 - SURGCENTER OF SAN DIEGO, LLC, ADVANCED SURGERY CENTER OF NORTH COUNTY | 820615296 - (CA) SURGCENTER OF SAN DIEGO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $560.00 | 1871841544 - SPALDING ENDOSCOPY CENTER, LLC | 453051061 - (GA) SPALDING ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46940 | $700.00 | 1033564414 - TEXAS CENTER FOR INTERVENTIONAL SURGERY, LLC | 811952779 - (TX) TEXAS CENTER FOR INTERVENTIONAL SURGERY LLC | TX | 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 46940 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46940 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 46940 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 |
|---|---|---|
| 46922-CPT | Moderate | Destruction Of Lesion(S), Anus (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Surgical Excision |
| 46924-CPT | Moderate | Destruction Of Lesion(S), Anus (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Extensive (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery) |
| 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 46940. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46940 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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