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See a sample rate comparisonCPT 49010 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.
Exploration Retroperitoneal A, Exploration Retroperitoneal Area With Or Without Biopsy(S) (Separate Procedure) Exploration Retroperitoneal Area With Or Without Biopsy(S)
| 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 78 - Return to OR - related procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49010 |
| Medicaid Fee Schedule | View Medicaid rates for 49010 |
National average reimbursement for CPT 49010 by major payers:
$1,164.90
$1,232.03
$1,325.30
$1,470.47
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CPT 49010
5 of 25 sample ratesHigher to lower in this preview
Ku Medwest Ambulatory Surgery Center, LLC
Ku Medwest Ambulatory Surgery Center LLC
$4,992.00Published rateTimonium Surgery Center, LLC
Timonium Surgery Center LLC
$3,500.00Published rateAuburn Surgery Center Inc.
Auburn Surgery Center Inc
$2,100.00Published rateAmerican Access Care Of Miami Asc LLC, Azura Surgery Center Miami
American Access Care Of Miami Asc LLC
$1,500.00Published rateAsc-Tcg, LLC, Tri-County Center For Endoscopy & Surgery
Asc - Tcg LLC
$640.00Published rate
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See a sample payer proposalCPT 49010 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49010 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 49010 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 | Exploratory Laparotomy Explor, Exploratory Laparotomy Exploratory Celiotomy Withorwithout Biopsy(S) (Separate Procedure) Explora Tory Laparotomy Exploratory Celiotomy With Or |
| 49002-CPT | High | Reopen Recent Laparotomy Incision |
| 49010-CPT | High | Exploration Retroperitoneal A, Exploration Retroperitoneal Area With Or Without Biopsy(S) (Separate Procedure) Exploration Retroperitoneal Area With Or Without Biopsy(S) |
| 49020-CPT | High | Drain Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49010. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49010 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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