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See a sample rate comparisonCPT 48540 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.
Intern Anastomsis Of Pancreatic Cyst To Gastrointes Tract; Rou, Internal Anastomosis Of Pancreatic Cyst To Gastrointestinal Tract; Rou
| 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 |
| Medicare Fee Schedule | View Medicare rates for 48540 |
| Medicaid Fee Schedule | View Medicaid rates for 48540 |
National average reimbursement for CPT 48540 by major payers:
$1,666.11
$1,742.28
$1,803.88
$2,121.63
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CPT 48540
5 of 25 sample ratesHigher to lower in this preview
Hospital For Special Surgery West Side Ambulatory Surgery Center, LLC, Hss West Side Asc, LLC
$5,387.00Published rateDoctors Outpatient Center For Surgery, LLC
Doctors Outpatient Center For Surgery LLC
$1,322.00Published rateThe Surgery Center, LLC
The Surgery Center LLC
$829.00Published rateAdvanced Eye Medical Group A Professional Corporation, Ophthalmology Medical Center
Advanced Eye Medical Group A Professional Corporation
$477.00Published rateIndiana Skin Cancer Ambulatory Surgical Center LLC
$80.00Published rate
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See a sample payer proposalCPT 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 | Anastomsis Roux-En-Y Of Extrahepatic Biliary Ducts & Gastrointe, Anastomosis Roux-En-Y Of Extrahepatic Biliary Ducts And Gastrointest |
| 48140-CPT | High | Pancreatectomy Distal Subtotal W//W/O Splenectomy; W/O, Pancreatectomy Distal Subtotal With Or Without Splenectomy; Without |
| 48153-CPT | High | Pancreatic Surgery, Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing Whipple-Type Procedure); With Pancreatojejunostomy |
| 48540-CPT | High | Intern Anastomsis Of Pancreatic Cyst To Gastrointes Tract; Rou, Internal Anastomosis Of Pancreatic Cyst To Gastrointestinal Tract; Rou |
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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