CPT 48150 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 | • 21 - Inpatient Hospital • 22 - On Campus-Outpatient Hospital • 19 - Off Campus-Outpatient Hospital |
| Common Modifiers | • None • 22 - Increased Procedural Services (surgical/procedures codes only) • GC - Service has been performed in part by a resident under the direction of a teaching physician |
| Complexity Level | High |
National average reimbursement for CPT 48150 by major payers:
$3,721.00
$4,150.89
$4,493.25
$5,049.71
| 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 48150 | ||||||
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CPT 48150 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48150 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 48150 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 |
|---|---|---|
| 47620 | High | Cholecystectomy With Exploration Of Common Duct; With Transduodenal Sphincterotomy Or Sphincteroplasty, With Or Without Cholangiography |
| 47720 | High | Cholecystoenterosotomy;Direct |
| 47741 | High | Creation Of Drainage Tract From Gallbladder To Small Bowel Using Roux-En-Y Connection And Creation Of Drainage Tract From Stomach To Small Bowel |
| 48150 | High | Pancreatectomy, Proximal Subtotal With Total Duodenectomy, Partial Gastrectomy, Choledochoenterostomy And Gastrojejunostomy (Whipple-Type Procedure); With Pancreatojejunostomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48150. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48150 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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