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See a sample rate comparisonCPT 48154 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.
Pancreatic Surgery, Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing Whipple-Type Procedure); Without Pancreatojejunostomy
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 48154 |
National average reimbursement for CPT 48154 by major payers:
$3,740.98
$3,865.20
$3,980.56
$4,694.00
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CPT 48154
5 of 25 sample ratesHigher to lower in this preview
Franciscan Surgery Center, LLC
$6,489.00Published rateCharlotte Endoscopic Surgery Center LLC, Charlotte Surgery Center
Charlotte Endoscopic Surgery Center, LLC
$1,028.00Published rateRetinal Ambulatory Surgery Center Of New York, Inc.
Retinal Ambulatory Surgery Center Of Ny, Inc.
$650.00Published rateUro-Center Ambulatory Surgical Center LLC
Urocenter Ambulatory Surgical Center LLC
$426.00Published rateAkdhc Surgery Center, LLC
$100.00Published rate
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See a sample payer proposalCPT 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 | Anastomsis Roux-En-Y Of Extrahepatic Biliary Ducts & Gastrointe, Anastomosis Roux-En-Y Of Extrahepatic Biliary Ducts And Gastrointest |
| 47785-CPT | High | Anastomsis Roux-En-Y Of Intrahepatic Biliary Ducts & Gastrointe, Anastomosis Roux-En-Y Of Intrahepatic Biliary Ducts And Gastrointest |
| 48152-CPT | High | Pancreatic Surgery, Pancreatectomy Proximal Subtotal With Total Duodenectomy Partial Gastrectomy Cholecystoenterostomy And Gastrojejunostomy (Whipple-Type Procedure); Without Pancreatojejunostomy |
| 48154-CPT | High | Pancreatic Surgery, 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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