CPT 49002 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 • 58 - Staged or related procedure during postoperative period • 78 - Return to OR - related procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49002 |
National average reimbursement for CPT 49002 by major payers:
$1,279.29
$1,352.13
$1,510.57
$1,665.47
| 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 49002 | ||||||
United | 49002 | $1049.00 | 1538773890 - ASC OF TRINITY, COMPREHENSIVE OUTPATIENT JOINT AND SPINE INSTITUTE | 833008593 - (FL) ASC OF TRINITY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $973.00 | 1942231493 - TAYLOR STATION SURGICAL CENTER LTD | 311459910 - (OH) TAYLOR STATION SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $505.00 | 1063427706 - PROHEALTH AMBULATORY SURGERY CENTER INC | 113447394 - (NY) PROHEALTH AMBULATORY SURGERY CENTER INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $425.00 | 1932657335 - VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES LLC, EAST COAST SURGERY CENTER | 300950557 - (FL) VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $2040.00 | 1154805646 - ANNE ARUNDEL-SCA SURGICENTER, LLC, AAMC SURGERY CENTER - ANNAPOLIS | 824763728 - (MD) ANNE ARUNDELSCA SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $380.00 | 1578525853 - GASTROINTESTINAL CENTER OF HIALEAH, LLC | 650173048 - (FL) GASTROINTESTINAL CENTER OF HIALEAH LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $440.00 | 1518264332 - SANTA FE SURGERY CENTER LLC | 272869086 - (FL) SANTA FE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $202.00 | 1043684129 - UNIVERSITY OF MARYLAND MEDICINE ASC, LLC, UNIVERSITY OF MARYLAND SURGERY CENTER | 472525050 - (MD) UNIVERSITY OF MARYLAND MEDICINE ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $705.00 | 1548710775 - LINCOLN DIGESTIVE HEALTH CENTER LLC | 371833798 - (NE) LINCOLN DIGESTIVE HEALTH CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $482.00 | 1427020213 - TOLEDO ENDOSCOPY ASC LLC, NORTHWEST OHIO ENDOSCOPY CENTER | 621734002 - (OH) TOLEDO ENDOSCOPY ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $477.00 | 1043473390 - LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP | 952858745 - (CA) LAKEWOOD EYE PHYSICIANS & SURGEONS, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $1141.00 | 1073039657 - UNIVERSITY ORTHOPEDICS, INC., UOI-EAST BAY SURGERY CENTER | 873506992 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $850.00 | 1124029384 - LGH-A/GOLF ASTC, LLC, GOLF SURGICAL CENTER | 363468942 - (IL) LGH-AGOLFASTCLLC.DBAGOLF SURGICAL CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $983.00 | 1548203888 - NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC, THE ORTHOPEDIC SURGERY CENTER OF ARIZONA | 202684773 - (AZ) NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49002 | $520.00 | 1740918887 - ORTHOMIDWEST SURGERY CENTER BELOIT, LLC | 881260648 - (WI) ORTHOMIDWEST SURGERY CENTER BELOIT LLC | WI | 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 49002 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49002 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 49002 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49002. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49002 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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