CPT 48999 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 • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 48999 by major payers:
$1,154.58
$245.46
$1,279.50
$1,603.05
| 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 48999 | ||||||
United | 48999 | $1389.00 | 1609400290 - ORTHOPAEDIC ASSOCIATES OF CENTRAL TEXAS SURGERY CENTER, LLC | 844818321 - (TX) ORTHOPAEDIC ASSOCIATES OF CENTRAL TEXAS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $659.00 | 1104990050 - FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | 911798298 - (NM) FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $2498.00 | 1053770149 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $1141.00 | 1104006006 - PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | 205755383 - (CA) PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $318.00 | 1093993727 - CAROLINA MOUNTAIN GASTROENTEROLOGY ENDOSCOPY CENTER | 261708694 - (NC) CAROLINA MOUNTAIN GASTROENTEROLOGY ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $967.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $350.00 | 1265816003 - CLEARVIEW SURGERY CENTER, LLC | 474123527 - (ID) CLEARVIEW SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $450.00 | 1659420727 - THE ENDOSCOPY CENTER, INC. | 460450119 - (SD) THE ENDOSCOPY CENTER INC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $405.00 | 1063649978 - IMPERIAL CALCASIEU SURGICAL CENTER LLC, CHRISTUS IMPERIAL CALCASIEU SURGICAL CENTER | 205109610 - (LA) IMPERIAL CALCASIEU SURGICAL CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $534.00 | 1821047499 - RIVERSIDE SURGERY CENTER, INC. | 680400319 - (CA) RIVERSIDE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $725.00 | 1790442895 - ORANGE AVENUE SURGERY CENTER, LLC | 873257002 - (FL) ORANGE AVENUE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $857.00 | 1336154152 - A CENTER FOR FOOT AND ANKLE SURGERY PA, THE CENTER FOR SPECIAL SURGERY OF HAWTHORNE | 223284458 - (NJ) A CENTER FOR FOOT AND ANKLE SU | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $367.00 | 1104199413 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC SUN CITY | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $1955.00 | 1962681130 - BAYLOR SURGICARE AT PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE - PLANO | 260308454 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 48999 | $280.00 | 1447600416 - POTTSTOWN AMBULATORY CENTER, LLC | 474556636 - (PA) POTTSTOWN AMBULATORY CENTER LL | PA | 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 48999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 48999 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 48999 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; |
| 48551-CPT | Moderate | Backbench Standard Preparation Of Cadaver Donor Pancreas Allograft Prior To Transplantation Including Dissection Of Allograft From Surrounding Soft Tissues Splenectomy Duodenotomy Ligatiin Of Bile Duct Ligation Of Mesenteric Vessels And Y-Graft Arterial Anastomoses From Iliac Artery To Superior Mesenteric Artery And To Splenic Artery |
| 48552-CPT | Moderate | Backbench Reconstruction Of Cadaver Donor Pancreas Allograft Prior To Transplantation, Venous Anastomosis, Each |
| 48999-CPT | High | Unlisted Procedure Pancreas |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 48999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 48999 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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