CPT 48153 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 |
| Common Modifiers | • None • 22 - Increased Procedural Services • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $3,008.87 Physician Fee Schedule |
National average reimbursement for CPT 48153 by major payers:
$3,895.65
$4,137.27
$4,448.92
$5,030.20
| 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 48153 | ||||||
United | 48153 | $1348.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $2397.00 | 1063641801 - PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC, NOVANT HEALTH HUNTERSVILLE OUTPATIENT SURGERY | 262422926 - (NC) PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $629.00 | 1295841666 - SURGERY CENTER OF SANDUSKY LLC, SURGERY CENTER OF SANDUSKY | 204913215 - (OH) SURGERY CENTER OF SANDUSKY LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $250.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $615.00 | 1518998764 - TENNESSEE PAIN SURGERY CENTER, LLC | 621790133 - (TN) TENNESSEE PAIN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $4115.00 | 1144612714 - ANCHORAGE SURGICENTER, LLC | 472881055 | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $794.00 | 1194437624 - WATAUGA SURGICAL PARTNERS PLLC | 862624496 - (TN) WATAUGA SURGICAL PARTNERS PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $800.00 | 1982931465 - GARDEN GROVE SURGICAL CENTER INC | 271203227 - (CA) GARDEN GROVE SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $424.00 | 1255347050 - MARYLAND EYE SURGERY CENTER, L.L.C., THE SURGERY CENTER | 522205280 - (MD) MARYLAND EYE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $2285.00 | 1083715148 - ASC SURGICAL VENTURES, LLC, OSMC OUTPATIENT SURGERY CENTER | 351995261 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $1591.00 | 1669705034 - EYE SPECIALISTS SURGERY CENTERS, LLC, MUNCIE SURGICAL CARE CENTER | 270927202 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $375.00 | 1922211192 - VOORHEES SURGERY CENTER, LLC | 651203770 - (NJ) VOORHEES SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $690.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $644.00 | 1699054098 - SURGCENTER OF WESTERN MARYLAND, LLC | 272969860 - (MD) SURGCENTER OF WESTERN MARYLAND, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48153 | $450.00 | 1831496231 - ANTELOPE VALLEY SURGERY CENTER, PC | 263584379 - (CA) ANTELOPE VALLEY SURGERY CENTER PC | CA | 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 48153 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48153 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 48153 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 |
|---|---|---|
| 47760-CPT | High | Anastomosis Exthepat Ducts+Gi Tract |
| 47785-CPT | High | Anastomosis, Roux-En-Y, Of Ntraheptic Biliary Ducts & Gstrontstnl Trct |
| 48150-CPT | High | Pancreatectomy, Proximal Subtotal With Total Duodenectomy, Partial Gastrectomy, Choledochoenterostomy And Gastrojejunostomy (Whipple-Type Procedure); With Pancreatojejunostomy |
| 48153-CPT | High | Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing 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 48153. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48153 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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