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See a sample rate comparisonCPT 48020 Fee Schedule
Last Verified: October 2026
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.
Remove Pancreatic Calculus
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 48020 |
| Medicaid Fee Schedule | View Medicaid rates for 48020 |
National average reimbursement for CPT 48020 by major payers:
$1,431.74
$1,551.70
$1,621.65
$1,905.27
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CPT 48020
5 of 25 sample ratesHigher to lower in this preview
Delaware Surgery Center, LLC
$4,300.00Published rateOrthovirginia, Inc
Orthovirginia, Inc.
$1,103.00Published rateGraystone Eye Surgery Center LLC
$770.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$565.00Published rateNorth River Surgery Center, LLC
North River Surgery Center LLC
$280.00Published rate
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See a sample payer proposalCPT 48020 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48020 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 48020 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 |
|---|---|---|
| 48020-CPT | High | Remove Pancreatic Calculus |
| 48100-CPT | High | Pancreas Biopsy, A Procedure To Remove A Sample Of Tissue From The Pancreas For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 48102-CPT | Moderate | Pancreas Biopsy, A Procedure To Remove A Sample Of Tissue From The Pancreas For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 48140-CPT | High | Pancreatectomy Distal Subtotal W//W/O Splenectomy; W/O, Pancreatectomy Distal Subtotal With Or Without Splenectomy; Without |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48020 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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