CPT 48540 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 • 51 - Multiple procedures • 22 - Increased Procedural Services |
| Complexity Level | High |
| CMS | $1,274.78 Physician Fee Schedule |
National average reimbursement for CPT 48540 by major payers:
$1,666.11
$1,742.28
$1,803.88
$2,121.63
| 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 48540 | ||||||
United | 48540 | $676.00 | 1295700086 - WESTERN WASHINGTON ENDOSCOPY CENTERS, LLC | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $900.00 | 1184660151 - INNOVATIVE PROCEDURAL CENTER LLC | 200327828 - (SD) INNOVATIVE PROCEDURE CENTER LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $456.00 | 1881948073 - CENTRAL OHIO UROLOGY SURGERY CENTER, LLC | 261240704 - (OH) CENTRAL OHIO UROLOGY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $656.00 | 1144845116 - LEGACY CENTER FOR SPINAL SURGERY, LLC | 843166515 - (GA) LEGACY CENTER FOR SPINAL SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $750.00 | 1093716037 - CATARACT AND REFRACTIVE SURGERY CENTER, LLC, NOVAMED SURGERY CENTER OF RICHMOND, LLC | 621865972 - (VA) CATARACT AND REFRACTIVE SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $390.00 | 1669428983 - CENTER FOR SPINE & PAIN MEDICINE, PC, CSPM AMBULATORY SURGERY | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $1158.00 | 1376536482 - BEND SURGERY CENTER LLC, BEND SURGERY CENTER | 911772048 - (OR) BEND SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $1136.00 | 1962435990 - NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC, CENTER FOR BONE AND JOINT SURGERY | 201026094 - (NJ) NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $1064.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $430.00 | 1265542849 - GREAT LAKES EYE SURGERY CENTER LLC | 205428461 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $229.00 | 1336185230 - Q CORP SURGERY CENTER INC, AFP SURGERY CENTER | 204910974 - (PA) Q CORP SURGERY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $350.00 | 1922071315 - SENECA PA ASC LLC, THE SURGERY AND LASER CENTER | 621806254 - (PA) SENECA PA ASC, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $528.00 | 1437601200 - UROPARTNERS SURGERY CENTER, LLC | 814131096 - (IL) UROPARTNERS SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $953.00 | 1154526044 - KERRVILLE AMBULATORY SURGERY CENTER, LLC | 205121858 - (TX) KERRVILLE AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48540 | $425.00 | 1457323107 - BOCA RATON OPHTHALMOLOGY ASC LLC, OUTPATIENT SURGERY CENTER OF BOCA RATON | 626350623 - (FL) BOCA RATON OPHTHALMOLOGY ASC 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 48540 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48540 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 48540 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 |
| 48140-CPT | High | Pancreatectomy Distal Subtotal |
| 48153-CPT | High | Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing Whipple-Type Procedure); With Pancreatojejunostomy |
| 48540-CPT | High | Anastom Cyst Pancreas-Gi Roux-En-Y |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48540 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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