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 |
| CMS | $2,811.56 Physician Fee Schedule |
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 | $139.00 | 1962556076 - AK SURGERY CENTER, LLC | 203332833 - (CA) AK SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1227.00 | 1023182086 - EAST TEXAS MEDICAL CENTER CARTHAGE, ETMC CARTHAGE | 824037220 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $531.00 | 1013914985 - ROANOKE AMBULATORY SURGERY CENTER, LLC, ROANOKE AMBULATORY SURGERY CENTER | 10691564 - (VA) ROANOKE AMBULATORY SURGERY | VA | 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 | $1028.00 | 1063099190 - ASCENSION SAINT THOMAS LEBANON SURGERY CENTER LLC, LEBANON SURGERY CENTER | 862679471 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $5495.00 | 1346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN | 471353602 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1064.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $725.00 | 1588267546 - BINGHAMTON ASC LLC, GREATER BINGHAMTON EYE SURGERY CENTER | 833672662 - (NY) BINGHAMTON ASC 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 | $743.00 | 1578593224 - K S MANAGEMENT SERVICES LLC, KELSEY-SEYBOLD ASC | 842241460 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $4300.00 | 1689639692 - SURGICAL CENTER OF SOUTH JERSEY LIMITED PARTNERSHIP | 222709324 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $289.00 | 1558007773 - HS SURGERY, PLLC | 862203027 - (MS) HS SURGERY PLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $780.00 | 1295119584 - WICHITA ASC LP, EPIC SURGERY CENTER | 471823557 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $1306.00 | 1205875283 - RWJ ENDOSURGICAL CENTER LLC | 900872940 - (NJ) RWJ ENDOSURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48154 | $230.00 | 1316253438 - TREASURE COAST UROLOGY CENTER, LLC | 273328667 - (FL) TREASURE COAST UROLOGY CENTER LLC | FL | 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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