CPT 48547 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 • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 78 - Return to OR - related procedure • 80 - Assistant surgeon • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 48547 |
National average reimbursement for CPT 48547 by major payers:
$2,268.16
$2,373.24
$2,463.77
$2,892.99
| 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 48547 | ||||||
United | 48547 | $412.00 | 1508879446 - WEST FLORIDA SURGERY CENTER INC | 651092124 - (FL) WEST FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $991.00 | 1467907287 - OPTUM CARE WASHINGTON PLLC, THE EDMONDS SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $668.00 | 1477178879 - SURGCENTER OF FAYETTEVILLE, LLC | 844038708 - (AR) SURGCENTER OF FAYETTEVILLE LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $2233.00 | 1700341468 - PORT WARWICK SURGERY CENTER, LLC | 832749039 - (VA) PORT WARWICK SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $97.00 | 1992735286 - CASTLEMAN SURGERY CENTER, LLC, SOUTHGATE SURGERY CENTER | 383029505 - (MI) CASTLEMAN SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $322.00 | 1205917101 - CATARACT & LASER CENTER, INC. | 42907424 - (MA) THE CATARACT AND LASER CENTER, I | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $797.00 | 1174590434 - HARMONY SURGERY CENTER, LLC, HARMONY AMBULATORY SURGERY CENTER, LLC | 841479751 - (CO) HARMONY SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $2785.00 | 1225091739 - OUTPATIENT WOMEN'S AND CHILDREN'S SURGERY CENTER, LTD | 432016059 - (TX) OUTPATIENT WOMENS AND CHILDRENS SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $5600.00 | 1578558763 - HUNT MEMORIAL HOSPITAL DISTRICT, HUNT REGIONAL HEALTHCARE | 751277293 - (TX) HUNT MEMORIAL HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $510.00 | 1114483492 - ORANGE COUNTY DIGESTIVE CENTER, INC | 832144265 - (CA) ORANGE COUNTY DIGESTIVE CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $500.00 | 1922178169 - IMPERIAL HEALTH, LLP | 721005645 - (LA) IMPERIAL HEALTH, LLP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $2785.00 | 1477516961 - CENTRUM SURGERY CENTER LTD | 752546712 - (CO) CENTRUM SURGERY CENTER LTD | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $1028.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $1640.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48547 | $760.00 | 1972758183 - DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC | 260448163 - (CT) DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE LLC | CT | 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 48547 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48547 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 48547 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 |
|---|---|---|
| 48148-CPT | High | Exc Ampulla Vater Simple |
| 48154-CPT | High | Pancreatectomy Proximal Subtotal With Near-Total Duodenectomy Choledochoenterostomy And Duodenojejunostomy (Pylorus-Sparing Whipple-Type Procedure); Without Pancreatojejunostomy |
| 48545-CPT | High | Pancreatorraphy For Trauma |
| 48547-CPT | High | Duodenal Exclusion With Gastrojejunostomy For Pancreatic Trauma |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48547. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48547 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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