CPT 49180 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
| CMS | $167.56 Physician Fee Schedule |
National average reimbursement for CPT 49180 by major payers:
$208.55
$230.44
$255.35
$278.36
| 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 49180 | ||||||
United | 49180 | $1233.00 | 1811001860 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $95.00 | 1538549852 - BAKERSFIELD SPECIALISTS SURGICAL CENTER, LLC | 465765998 - (CA) BAKERSFIELD SPECIALISTS SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1528.00 | 1427326677 - ENCINITAS ENDOSCOPY CENTER, LLC, THE ENDOSCOPY CENTER | 453608354 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1328.00 | 1255386348 - SURGERY CENTER OF CHATTANOOGA LP | 113765793 - (TN) SURGERY CENTER OF CHATTANOOGA LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1250.00 | 1760616031 - BLAINE MN MULTI SPECIALTY ASC LLC, NORTH METRO SURGERY CENTER | 262868539 - (MN) BLAINE MN MULTI SPECIALTY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1340.00 | 1821510579 - NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC, NOVANT HEALTH BRUNSWICK ENDOSCOPY | 820831203 - (NC) NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $916.00 | 1043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER | 911954101 - (WA) SKIN SURGERY CENTER P. S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $580.00 | 1669660817 - SPH IRVINE, L.L.C. | 752507129 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $670.00 | 1356890172 - DIALYSIS ACCESS SERVICES, LLC | 472322456 - (MD) DIALYSIS ACCESS SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1520.00 | 1922526961 - BLAINE ASC, LLC, BLAINE ORTHOPEDIC SURGERY CENTER | 822416401 - (MN) BLAINE ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $2709.00 | 1508974353 - SOUTHLAKE AMBULATORY SURGERY CENTER, LLLP, SPIVEY STATION SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $580.00 | 1487169769 - ELKRIDGE ASC LLC | 475585574 - (MD) ELKRIDGE ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $1300.00 | 1245862002 - QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC, QUINCY MEDICAL GROUP SURGERY CENTER | 371206525 - QUINCY PHYSICIANS & SURGEONS CLINIC S.C. D/B/A QUINCY MEDICAL GROUP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $580.00 | 1013068642 - RENAISSANCE SURGERY CENTER, LLC | 205977652 - (CA) RENAISSANCE SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49180 | $614.00 | 1871260554 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | 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 49180 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49180 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 49180 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 |
|---|---|---|
| 49010-CPT | High | Explore,Retroperitoneal Area W/Wo Bx-Sep |
| 49060-CPT | High | Drain Absc Retroperitoneal |
| 49180-CPT | Moderate | Biopsy Mass Retroperitoneal Needle |
| 49320-CPT | Moderate | Laparoscopy, Abdomen, Peritoneum, And Omentum, Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49180. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49180 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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