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 |
| Medicare Fee Schedule | View Medicare rates for 49040 |
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 | $829.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $1314.00 | 1003860917 - SURGERY CENTER OF PINEHURST, LLC | 680561185 - (NC) SURGERY CENTER OF PINEHURST LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $285.00 | 1730382789 - ENDOSCOPY CENTER | 260317060 - (NC) ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $644.00 | 1275376121 - CLEARWAY SURGERY CENTER OF NATIONAL HARBOR LLC | 454110190 - (MD) HARBORSIDE SURGERY CENTER | 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 | $1064.00 | 1811385883 - CENTRAL DELAWARE ENDOSCOPY UNIT LLC | 471840129 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $1030.00 | 1831551266 - INOV8 SURGICAL AT MEMORIAL CITY, INOV8 SURGICAL | 475640889 - (TX) INOV8 SURGICAL AT MEMORIAL CITY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $610.00 | 1205871050 - KLAMATH SURGERY CENTER LLC, KLAMATH SURGEONS LLC | 911836091 - (OR) KLAMATH SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $2172.00 | 1508871211 - TEXAS DIGESTIVE DISEASE CENTER, LTD | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $1344.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $247.00 | 1205804697 - GOLDSBORO ENDOSCOPY CENTER INC | 562003095 - (NC) GOLDSBORO ENDOSCOPY CENTER INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $550.00 | 1437505948 - WATER LEAF SURGERY CENTER, LTD | 811356283 - (TX) WATER LEAF SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $729.00 | 1619013455 - RUSH SURGICENTER AT THE PROFESSIONAL BUILDING LTD. PARTNERSHIP, RUSH SURGICENTER LTD. PARTNERSHIP | 363853026 - (IL) RUSH SURGICENTER, LTD. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $840.00 | 1548842180 - DIGESTIVE HEALTH CENTER LLC | 853810510 - (IA) DIGESTIVE HEALTH CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49040 | $398.00 | 1295494359 - ATLANTIC SC LLC | 832941937 - (NY) ATLANTIC SC LLC | NY | 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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