CPT 48154 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 |
| Common Modifiers | • None • 22 - Increased Procedural Services • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 48154 |
National average reimbursement for CPT 48154 by major payers:
$3,740.98
$3,865.20
$3,980.56
$4,694.00
| 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 48154 | ||||||
United | 48154 | $687.00 | 1174938344 - SPECIALTY SURGERY CENTER, LLC | 455554765 - (MS) SPECIALTY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $6343.00 | 1104850312 - MONTEREY PENINSULA SURGERY CENTER LLC | 770470910 - (CA) MONTEREY PENINSULA SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $727.00 | 1265488563 - SYRACUSE ASC, LLC, SPECIALTY SURGERY CENTER OF CNY | 161549512 - (NY) SPECIALTY SURGERY CENTER OF CNY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $564.00 | 1750468583 - TEXAS EYE SURGERY CENTER, LLC | 202928367 - (TX) TEXAS EYE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $271.00 | 1851317614 - KENDALL POINTE SURGERY CENTER LLC | 364236445 - (IL) KENDALL POINTE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $2172.00 | 1184689010 - PARK CITIES SURGERY CENTER, LLC, PARK CITIES SURGERY CENTER | 562357079 - (TX) PARK CITIES SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1124.00 | 1023604931 - ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | 854282481 - (AZ) ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $650.00 | 1508810656 - RETINAL AMBULATORY SURGERY CENTER OF NEW YORK, INC. | 134189700 - (NY) RETINAL AMBULATORY SURGERY CENTER OF NY, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $500.00 | 1629175062 - SARATOGA SCHENECTADY ENDOSCOPY CENTER, LLC | 550867698 - (NY) SARATOGA SCHENECTADY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $650.00 | 1841259694 - ENT FACIAL SURGERY CENTER LLC | 770470934 - (CA) ENT FACIAL SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $589.00 | 1093449225 - NARROWS SURGERY CENTER PS | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1028.00 | 1730175159 - CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC, CHARLOTTE SURGERY CENTER | 651071112 - (FL) CHARLOTTE ENDOSCOPIC SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $880.00 | 1750343083 - LEXINGTON SURGERY CENTER LTD | 611028180 - (KY) LEXINGTON SURGERY CENTER LTD | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $509.00 | 1639498579 - INTERVENTIONAL SPINE CENTER, LLC | 263161503 - (CA) INTERVENTIONAL SPINE CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1313.00 | 1679235584 - ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | 872158427 - (MN) ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | MN | 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 48154 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48154 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 48154 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 |
|---|---|---|
| 47780-CPT | High | Anastomos Roux-En-Y Exthep Ducts+Gi |
| 47785-CPT | High | Anastomosis, Roux-En-Y, Of Ntraheptic Biliary Ducts & Gstrontstnl Trct |
| 48152-CPT | High | Pancreatectomy, Proximal Subtotal With Total Duodenectomy, Partial Gastrectomy, Choledochoenterostomy And Gastrojejunostomy (Whipple-Type Procedure); Without Pancreatojejunostomy |
| 48154-CPT | High | Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing Whipple-Type Procedure); Without Pancreatojejunostomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48154. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48154 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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