CPT 48160 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 • 62 - Co-Surgeons • 22 - Increased Procedural Services |
| Complexity Level | High |
National average reimbursement for CPT 48160 by major payers:
$3,457.42
$4,132.79
$4,049.17
$5,965.30
| 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 48160 | ||||||
United | 48160 | $347.00 | 1154538544 - COLLIER ENDOSCOPY & SURGERY CENTER | 651093702 - (FL) COLLIER ENDOSCOPY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $839.00 | 1720332810 - PAIN, SPINE & REHAB.,A.S.C.,P.A. | 461221966 - (KS) PAIN SPINE REHABASCPA | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $615.00 | 1699246181 - DEERBROOK ASC LLC | 823478937 - (TX) DEERBROOK ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $391.00 | 1902079775 - ORLANDO MILLS FL ENDOSCOPY ASC LLC, CENTER FOR DIGESTIVE ENDOSCOPY | 262277693 - (FL) ORLANDO MILLS FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $600.00 | 1194970418 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $6068.00 | 1285976183 - TEXAS HEALTH FLOWER MOUND ORTHOPEDIC SURGERY CENTER LLC | 800866449 - (TX) TEXAS HEALTH FLOWER MOUND ORTHOPEDIC SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $983.00 | 1841395894 - FRANKLIN ENDOSCOPY CENTER, LLC, FRANKLIN ENDOSCOPY CENTER | 383730672 - (TN) FRANKLIN ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $523.00 | 1881151108 - ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | 833191352 - (GA) ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $125.00 | 1619923661 - DELTA ENDOSCOPY CENTER, P.C. | 640903701 - (MS) DELTA ENDOSCOPY CENTER PC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $473.00 | 1841733326 - AU SURGERY CENTER, LLC | 814545748 - (GA) AU SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $910.00 | 1316317134 - SUMMER STREET ASC LLC | 474990107 - (CT) SUMMER STREET ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $2732.00 | 1659473924 - MID-AMERICA SURGERY INSTITUTE LLC | 50564556 - (KS) MIDAMERICA SURGERY INSTITUTE LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $1146.00 | 1154911592 - BCC WEST VALLEY LLC | 854264663 - (AZ) BCC WEST VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $253.00 | 1346270428 - BALTIMORE AMBULATORY CENTER FOR ENDOSCOPY | 521913193 - (MD) BALTIMORE AMBULATORY CENTER FO | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48160 | $737.00 | 1972911030 - SOUTHEASTERN AMBULATORY SURGERY CENTER, LLC, THE SURGERY CENTER AT SOUTHEASTERN HEALTH PARK | 452413077 - (NC) SOUTHEASTERN AMBULATORY SURGERY CENTER, LLC | NC | 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 48160 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48160 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 48160 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 |
| 48552-CPT | Moderate | Backbench Reconstruction Of Cadaver Donor Pancreas Allograft Prior To Transplantation, Venous Anastomosis, Each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48160 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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