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See a sample rate comparisonCPT 49180 Fee Schedule
Last Verified: October 2026
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.
Abdominal Mass Needle Biopsy, A Procedure To Insert A Needle Into The Abdomen In Order To Remove A Sample Of Tissue From A Mass For Testing (Biopsy).
| 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 |
| Medicare Fee Schedule | View Medicare rates for 49180 |
| Medicaid Fee Schedule | View Medicaid rates for 49180 |
National average reimbursement for CPT 49180 by major payers:
$208.55
$230.44
$255.35
$152.43
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CPT 49180
5 of 25 sample ratesHigher to lower in this preview
Cadence Ambulatory Surgery Center, LLC
$4,015.00Published rateBanner Phoenix Surgery Center LLC
$947.00Published rateDialysis Access Services, LLC
Dialysis Access Services LLC
$670.00Published rateOklahoma Spine Surgery Center
$561.00Published rateDoctors Surgery Center, Inc
Doctors Surgery Center Inc
$300.00Published rate
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See a sample payer proposalCPT 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 | Exploration Retroperitoneal A, Exploration Retroperitoneal Area With Or Without Biopsy(S) (Separate Procedure) Exploration Retroperitoneal Area With Or Without Biopsy(S) |
| 49060-CPT | High | Drain Infection From Abdomen, Surgery To Drain Abscess (Pocket Of Infection) Located In The Peritoneum (Lining Of The Abdominal Cavity). |
| 49180-CPT | Moderate | Abdominal Mass Needle Biopsy, A Procedure To Insert A Needle Into The Abdomen In Order To Remove A Sample Of Tissue From A Mass For Testing (Biopsy). |
| 49320-CPT | Moderate | Laparoscopy Surgical Abdomen, Laparoscopy Surgical 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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