CPT 48155 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 • 51 - Multiple procedures • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 48155 |
National average reimbursement for CPT 48155 by major payers:
$2,428.55
$2,400.71
$2,544.66
$2,949.22
| 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 48155 | ||||||
United | 48155 | $1129.00 | 1730277575 - BEDFORD AMBULATORY SURGICAL CENTER, LLC | 20519727 - (NH) BEDFORD AMBULATORY SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $1036.00 | 1962893354 - WESTMORELAND ASC, LLC, APEX SURGICAL CENTER | 462808005 - (NY) WESTMORELAND ASC, LLC DBA APEX | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $400.00 | 1356369755 - MADISON SURGERY CENTER, LLC | 631249522 - (AL) MADISON SURGERY CENTER, L.L.C. | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $200.00 | 1649407180 - PAIN MDS INC | 270279190 - (AZ) PAIN MDS INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $508.00 | 1780206292 - GREECE ASC, LLC, CORNERSTONE SURGERY CENTER | 824108616 - (NY) GREECE ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $724.00 | 1265486849 - FEATHERSTONE PARTNERSHIP LP, ROCKFORD AMBULATORY SURGERY CENTER | 363861021 - (IL) THE FEATHERSTONE PARTNERSHIP L. P. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $900.00 | 1225123227 - COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | 770533953 - (CA) COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $615.00 | 1962453175 - THE SURGERY CENTER OF ATHENS, LLC. | 800812776 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $1167.00 | 1336649565 - ADVANCED SURGICAL CARE OF ST. LOUIS, LLC | 823086965 - (MO) ADVANCED SURGICAL CARE OF ST LOUIS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $1064.00 | 1538390539 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $225.00 | 1235165531 - LAKE SURGERY & ENDOSCOPY CENTER LTD | 593325730 - (FL) LAKE SURGERY ENDOSCOPY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $1042.00 | 1801944343 - HUDSON VALLEY AMBULATORY SURGERY, LLC | 510451539 - (NY) HUDSON VALLEY AMBULATORY | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $1424.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $775.00 | 1952360059 - MAINE EYE CARE ASSOCIATES, MAINE EYE CARE SURGERY CENTER | 10316462 - (ME) EYE CARE OF MAINE, P.A. F/K/A MAINE EYE CARE, P.A. | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48155 | $158.00 | 1285633818 - FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | 522208568 - (MD) FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | MD | 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 48155 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48155 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 48155 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 |
|---|---|---|
| 48155-CPT | High | Pancreatectomy Total; |
| 48160-CPT | High | Pancreatectomy Total W Transplant |
| 48550-CPT | High | Donor Pancreatectomy With Preparation And Maintenance Of Allograft From Cadaver Donor With Or Without Duodenal Segment For Transplantation |
| 48554-CPT | High | Transplantation Of Pancreatic Allograft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48155. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48155 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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