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See a sample rate comparisonCPT 49040 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.
Drain Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity).
| 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 |
| Medicare Fee Schedule | View Medicare rates for 49040 |
| Medicaid Fee Schedule | View Medicaid rates for 49040 |
National average reimbursement for CPT 49040 by major payers:
$1,173.49
$1,321.21
$1,352.70
$1,589.17
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CPT 49040
5 of 25 sample ratesHigher to lower in this preview
Pontchartrain Lithotripsy, LLC
Pontchartrain Lithotripsy LLC
$5,500.00Published rateSurgery Center Of Fort Wayne
Surgery Center Of Fort Wayne LLC
$1,250.00Published rateSurgery Center Of Athens LLC
$829.00Published rateThomasville Surgery Center, Inc.
Thomasville Surgery Center Inc
$400.00Published rateSebastopol Asc, L.P.
Sebastopol Asc Lp
$88.00Published rate
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See a sample payer proposalCPT 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 Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity). |
| 49040-CPT | High | Drain Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity). |
| 49060-CPT | High | Drain Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity). |
| 49185-CPT | High | Sclerotx Fluid Collection, 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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