CPT 49185 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $1,162.86 Physician Fee Schedule |
National average reimbursement for CPT 49185 by major payers:
$1,238.25
$1,462.14
$1,675.70
$1,875.30
| 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 49185 | ||||||
United | 49185 | $575.00 | 1235466863 - AESTHETIC ASSOCIATES INC., P.S, SEATTLE FACIAL PLASTIC SURGERY CENTER | 911650765 - (WA) AESTHETIC ASSOCIATES INC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $2350.00 | 1376790691 - MEMORIAL HERMANN ENDOSCOPY & SURGERY CENTER NORTH HOUSTON, LLC, NORTH HOUSTON ENDOSCOPY & SURGERY CENTER | 262809136 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $1860.07 | 1538267281 - DMITRIY SINTSOV | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 49185 | $744.00 | 1598165664 - WESTHEALTH SURGERY CENTER LLC | 371763155 - (MN) WESTHEALTH SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $854.63 | 1467646752 - TRACY DENO-BUECHLEIN | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 49185 | $854.63 | 1043640840 - ERNEST GROSS | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 49185 | $1849.00 | 1699702050 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON BELLEVUE ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $447.00 | 1417904756 - METROPOLITAN MEDICAL CENTER, LLC | 202804280 - (WI) METROPOLITAN MEDICAL CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $1020.00 | 1730277575 - BEDFORD AMBULATORY SURGICAL CENTER, LLC | 20519727 - (NH) BEDFORD AMBULATORY SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $1860.07 | 1881129286 - JOEL PHELPS | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 49185 | $2350.00 | 1659301794 - MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER, LLP, MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER | 203233666 - (TX) MEMORIAL HERMANN SURGERY CENTER TEXAS MEDICAL CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $523.00 | 1730113325 - DHA ENDOSCOPY LLC | 43551976 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $967.00 | 1366559122 - HARVARD PARK SURGERY CENTER, LLC, HARVARD PARK SURGERY CENTER | 331107194 - (CO) HARVARD PARK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $953.00 | 1992713176 - DESERT RIDGE OUTPATIENT SURGERY LLC | 202528902 - (AZ) DESERT RIDGE OUTPATIENT SURGERY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49185 | $953.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | 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 49185 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49185 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 49185 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 |
| 49082-CPT | Moderate | Once Per Dos Abdominal Paracentesis (Diagnostic Or Therapeutic); W/O Imaging Guidance |
| 49083-CPT | Moderate | Once Per Dos Abdominal Paracentesis (Diagnostic Or Therapeutic); W/Imaging Guidance |
| 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 49185. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49185 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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