CPT 49040 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 • 23 - Emergency Room |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 80 - Assistant surgeon |
| Complexity Level | High |
| CMS | $982.36 Physician Fee Schedule |
National average reimbursement for CPT 49040 by major payers:
$1,173.49
$1,321.21
$1,352.70
$1,621.95
| 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 49040 | ||||||
United | 49040 | $898.00 | 1902472715 - CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC, CARTI SURGERY CENTER | 710437657 - (AR) CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $773.00 | 1174538748 - SPECIALTY SURGICAL CENTER, LLC, SPECIALTY SURGICAL CENTER | 954698130 - (CA) SPECIALTY SURGICAL CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $13332.00 | 1285639062 - OHIO ORTHOPEDIC SURGERY INSTITUTE LLC | 431939917 - (OH) OHIO ORTHOPEDIC SURGERY INSTITUTE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $750.00 | 1437123270 - EDINA MN OPHTHALMOLOGY ASC LLC, MCCANNEL EYE SURGERY | 200487963 - (MN) EDINA MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $558.00 | 1669481255 - SURGERY CENTER OF CULLMAN LLC, HEALTHSOUTH/WOODLANDS SURGERY CENTER OF CULLMAN, LLC | 203489003 - (AL) SURGERY CENTER OF CULLMAN LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $760.00 | 1366181778 - AXION SPINE OUTPATIENT SURGERY CENTER | 881709019 - (GA) AXION SPINE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $672.00 | 1427355080 - PINNACLE ORTHOPAEDICS SURGERY CENTER WOODSTOCK, LLC, PINNACLE ORTHOPAEDICS SURGERY CENTER WOODSTOCK, LLC | 272900107 - (GA) PINNACLE ORTHOPAEDICS SURGERY CENTER WOODSTOCK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $1250.00 | 1780218115 - SURGERY CENTER OF FORT WAYNE | 825163478 - (IN) SURGERY CENTER OF FORT WAYNE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $384.00 | 1750612446 - BAY SURGERY CENTERS, CLEARWAY SURGERY CENTER OF GLEN BURNIE | 271271303 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $283.00 | 1285283432 - JONESBORO AMBULATORY SURGERY CENTER, LLC | 832479059 - (AR) JONESBORO AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $128.00 | 1598797714 - SURGERY CENTER OF LYNCHBURG LLC | 541935354 - (VA) SURGERY CENTER OF LYNCHBURG LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $983.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $2172.00 | 1508871211 - TEXAS DIGESTIVE DISEASE CENTER, LTD | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $474.00 | 1194718312 - CAPE COD ASC LLC | 43424805 - (MA) CAPE COD ASSOC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $455.00 | 1063417285 - LARGO ENDOSCOPY CENTER LP, TAMPA BAY REGIONAL SURGERY CENTER | 731631684 - (FL) LARGO ENDOSCOPY CENTER LP | 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 49040 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49040 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 49040 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 |
|---|---|---|
| 49020-CPT | High | Drain Absc/Local Inflam Peritoneal |
| 49040-CPT | High | Drainage Subdiaphragmaticor Subphrenic |
| 49060-CPT | High | Drain Absc Retroperitoneal |
| 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 49040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49040 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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