CPT 47538 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | High |
| CMS | $3,425.82 Physician Fee Schedule |
National average reimbursement for CPT 47538 by major payers:
$4,215.52
$5,834.59
$5,565.12
$6,319.46
| 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 47538 | ||||||
United | 47538 | $6365.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $3300.00 | 1750036174 - GLACIER SURGICAL INC. | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $10491.00 | 1538179551 - HENRY FORD MEDICAL CENTER FAIRLANE, HENRY FORD HEALTH SYSTEM | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $1053.00 | 1629152053 - ISLAND EYE SURGICENTER LLC | 113486191 - (NY) ISLAND EYE SURGICENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $1033.00 | 1376574814 - ROCHESTER ENDOSCOPY & SURGERY CENTER, L.L.C. | 61683897 - (MI) ROCHESTER ENDOSCOPY SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $3433.75 | 1144740549 - DAVID MAVER | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 47538 | $5019.00 | 1881701290 - WASATCH ENDOSCOPY CENTER LTD | 621600427 - (UT) WASATCH ENDOSCOPY CENTER LTD | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $5300.00 | 1528332186 - LINDENHURST SURGERY CENTER LLC, RED OAKS SURGICAL SUITES | 364711459 - (IL) LINDENHURST SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $5330.00 | 1477584621 - HANOVER NJ ENDOSCOPY ASC LLC, HANOVER ENDOSCOPY CENTER | 201272329 - (NJ) HANOVER NJ ENDOSCOPY ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $5343.00 | 1588785208 - AMBER MEADOWS SURGERY CENTER LLC | 208756114 - (MD) AMBER MEADOWS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $6429.00 | 1245529189 - CAPITOL SURGICAL CENTER LLC | 275067646 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $4867.00 | 1992788384 - ASPEN SURGERY VENTURE LLC, ASPEN SURGERY CENTER | 263913327 - (CA) ASPEN SURGERY VENTURE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $6087.00 | 1588260343 - ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC, ADVENTHEALTH SURGERY CENTER WELLSWOOD | 854111089 - (FL) ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $7888.00 | 1245820042 - ALOE SURGICAL CENTER SCOTTSDALE, LLC | 845112576 - (AZ) ALOE SURGICAL CENTER SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 47538 | $3100.00 | 1578088787 - VACCO LLC | 821221738 - (OH) VACCO LLC | OH | 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 47538 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 47538 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 47538 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 |
|---|---|---|
| 47538-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiography Imaging Guidance (Eg Fluoroscopyand/Or Ultrasound) Balloon Dilation Catheter Exchange(S) And Catheter Removal(S) When Performed And All Associated Radiological Supervision And Interpretation; Existing Access. (Desc Revised 1/1/2017) |
| 47539-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiographyimaging Guidance (Eg Fluoroscopy And/Or Ultrasound) Balloon Dilation Catheter Exchange Or Removal When Performed And All Associated Radiological Supervision And Interpretation Each Stent; New Access Without Placement Of Separate Biliary Drainage Catheter. |
| 47540-CPT | High | Placement Of Stent(S) Into A Bile Duct Percutaneous Including Diagnostic Cholangiographyimaging Guidance (Eg Fluoroscopy And/Or Ultrasound) Balloon Dilation Catheter Exchange Or Removal When Performed And All Associated Radiological Supervision And Interpretation Each Stent; New Access With Placement Of Separate Biliary Drainage Catheter (Eg External Or Internal-External). |
| 47541-CPT | High | Placement Of Access Through The Biliary Tree And Into Small Bowel To Assist With An Endoscopic Biliary Procedure (Eg Rendezvous Procedure) Percutaneous Including Diagnostic Cholangiographywhen Performed Imaging Guidance (Eg Ultrasound And/Or Fluoroscopy) And All Associated Radiological Supervision And Interpretation; New Access. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 47538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 47538 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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