CPT 46999 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 11 - Office |
| Common Modifiers | • None • 51 - Multiple procedures • UB |
| Complexity Level | High |
National average reimbursement for CPT 46999 by major payers:
$1,267.62
$92.71
$1,417.73
$818.28
| 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 46999 | ||||||
United | 46999 | $280.00 | 1912476367 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $261.00 | 1780727636 - UNION SURGERY CENTER, INC, ADVANCED ENDOSCOPY CENTER | 205205858 - (CA) UNION SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $953.00 | 1083176309 - SPICEWOOD SURGERY CENTER LLC, SPICEWOOD SURGERY CENTER | 834343089 - (TX) SPICEWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $1849.00 | 1154460525 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON LYNNWOOD ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $993.00 | 1588328918 - HARLEM ROAD AMBULATORY SURGERY CENTER LLC | 833648797 - (NY) HARLEM ROAD AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $953.00 | 1831180272 - ADVANCED ENDOSCOPY CENTER LLC | 861083384 - (MO) ADVANCED ENDOSCOPY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $204.00 | 1245868488 - AVON SURGERY CENTER, LLC | 823987550 - (OH) AVON SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $351.00 | 1386641066 - EYE SURGERY CENTER OF MARYVILLE LLC, EYES OF ILLINOIS SURGERY CENTER | 364111317 - (IL) NOVAMED EYE SURGERY CENTER OF MARYVILLE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $220.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $967.00 | 1841231792 - NORTH HAVEN SURGERY CENTER LLC, NORTH HAVEN PAIN MEDICINE CENTER, LLC | 770656233 - (CT) NORTH HAVEN SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $238.00 | 1639365240 - SAVANNAH PAIN CENTER, LLC | 203978153 - (GA) SAVANNAH PAIN CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $169.00 | 1548263619 - AZAR EYE SURGERY CENTER LLC | 522325381 - (MD) AZAR EYE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $1013.00 | 1689852618 - MILLARD FILLMORE SURGERY CENTER, LLC | 261582864 - (NY) MILLARD FILLMORE SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $967.00 | 1740794973 - EPIC ASC, LLC, EPIC SURGERY CENTER | 611859657 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 46999 | $350.00 | 1285944504 - NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC | 272840356 - (MD) NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK LLC | MD | 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 46999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46999 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 46999 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 |
|---|---|---|
| 46746-CPT | High | Repair Of Defect For Single Channel Outlet Of Rectum, Vagina, And Urinary Tract Through Abdomen And Region Between Thighs Or Below Sacrum |
| 46750-CPT | Moderate | Sphincteropl,Anal-Prolapse;Adult |
| 46922-CPT | Moderate | Destruction Of Lesion(S), Anus (Eg, Condyloma, Papilloma, Molluscum Contagiosum, Herpetic Vesicle), Simple; Surgical Excision |
| 46999-CPT | High | Unlisted Procedure, Anus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46999 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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