CPT 49000 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49000 |
National average reimbursement for CPT 49000 by major payers:
$947.68
$1,027.61
$1,114.63
$1,261.96
| 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 49000 | ||||||
United | 49000 | $1916.00 | 1891722609 - EYE MDS OF PUGET SOUND PLLC, NARROWS EYE SURGERY CENTER | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $680.00 | 1528012978 - NORTHERN CALIFORNIA SURGERY CENTER LP | 680561196 - (CA) NORTHERN CALIFORNIA SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $680.00 | 1356965750 - PROLIANCE SURGERY CENTER AT VALLEY, LLC | 842108616 - (WA) PROLIANCE SURGERY CENTER AT VALLEY LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $3570.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $1290.00 | 1174530752 - LAKE MARY SURGERY CENTER LLC | 134215228 - (FL) LAKE MARY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $1603.00 | 1104877976 - VICTOR R. MICHALAK, DBA COSMETIC SURGERY & DERMATOLOGY OF ISSAQUAH, INC. | 911521306 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $1320.00 | 1790721769 - SAN FRANCISCO SURGERY CENTER, LP | 870689493 - (CA) SAN FRANCISCO SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $4633.00 | 1619218096 - SAN MARCOS ASC LLC | 800899088 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $2549.00 | 1124086608 - LUTHERAN CAMPUS ASC LLC, THE SURGERY CENTER AT LUTHERAN | 20749532 - (CO) LUTHERAN CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $3623.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $1320.00 | 1669540118 - STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC, VALLEY LASER SURGERY CENTER, INC. | 203111961 - (CA) STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $10099.00 | 1497393516 - AURORA SURGERY CENTERS, LLC, AURORA PLEASANT PRAIRIE AMBULATORY SURGERY CENTER | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $2600.00 | 1255728499 - SUMMIT ATLANTIC SURGERY CENTER LLC | 473235212 - (NJ) SUMMIT ATLANTIC SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $3623.00 | 1114253093 - CRESCENT CITY SURGERY CENTER LLC | 271113561 - (IN) CRESCENT CITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49000 | $3570.00 | 1992250922 - MIAMI SURGICAL SUITES LLC | 474339341 - (FL) MIAMI SURGICAL SUITES 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 49000 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49000 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 49000 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 |
|---|---|---|
| 49000-CPT | Moderate | Laparotomy/Celiotomy Exploratory |
| 49002-CPT | High | Reopen Recent Laparotomy Incision |
| 49010-CPT | High | Explore,Retroperitoneal Area W/Wo Bx-Sep |
| 49185-CPT | High | Sclerotherapy Of A Fluid Collection (Eg Lymphocele Cyst Or Seroma) Percutaneous Including Contrast Injection(S) Sclerosant Injection(S) Diagnostic Study Imaging Guidance (Eg Ultrasound Fluoroscopy) And Radiological Supervision And Interpretation When Performed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49000 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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