CPT 49186 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 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49186 |
National average reimbursement for CPT 49186 by major payers:
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| 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 49186 | ||||||
United | 49186 | $468.00 | 1922075969 - SAINT MARY'S AMBULATORY SURGERY | 550837980 - (NJ) SAINT MARYS AMBULATORY SURGERY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $872.00 | 1225568884 - WAKE FOREST AMBULATORY VENTURES, LLC | 820777206 - (NC) WAKE FOREST AMBULATORY VENTURES LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $553.00 | 1508810656 - RETINAL AMBULATORY SURGERY CENTER OF NEW YORK, INC. | 134189700 - (NY) RETINAL AMBULATORY SURGERY CENTER OF NY, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $671.00 | 1295463990 - SHARPEVISION PLLC | 454849447 - (WA) SHARPEVISION, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $1347.00 | 1750517561 - CANON CITY CO MULTI SPECIALTY ASC LLC, ARKANSAS VALLEY SURGERY CENTER | 264730485 - (CO) CANON CITY CO MULTI SPECIALTY ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $862.00 | 1073763652 - LEBONHEUR EAST SURGERY CENTER II LP, LEBONHEUR EAST SURGERY CENTER LP | 800247391 - (TN) LEBONHEUR EAST SURGERY CENTER II LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $694.00 | 1740254572 - THE NORTHERN NV ENDOSCOPY ASC LLC, DIGESTIVE HEALTH CENTER | 200470103 - THE NORTHERN NV ENDOSCOPY ASC LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $1000.00 | 1063838357 - METROEAST ENDOSCOPIC SURGERY CENTER | 461844105 - (IL) METROEAST ENDOSCOPIC SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $390.00 | 1083606867 - NOVAMED SURGERY CENTER OF TYLER, LP, CATARACT CENTER OF EAST TEXAS | 680510003 - (TX) NOVAMED SURGERY CENTER OF TYLER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $171.00 | 1497869267 - DOCTORS SURGERY CENTER, INC | 752545398 - (TX) DOCTORS SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $90.00 | 1528009453 - TGLP, LP, THE ENDOSCOPY CENTER OF TEXARKANA | 201584968 - (TX) TGLP LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $643.00 | 1811057029 - GREENSBORO NC ENDOSCOPY ASC LLC, GUILFORD ENDOSCOPY CENTER | 203802443 - (NC) GREENSBORO NC ENDOSCOPY ASC LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $504.00 | 1770528838 - BREVARD SURGERY CENTER | 593128478 - (FL) BREVARD SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $730.00 | 1770019200 - GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC, GEORGIA CATARACT AND EYE SPECIALTY CENTER | 461115901 - (GA) GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49186 | $1664.00 | 1073505038 - PALMETTO SURGERY CENTER LLC | 582333248 - (SC) PALMETTO SURGERY CENTER, LLC | SC | 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 49186 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49186 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 49186 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 |
|---|---|---|
| 49186-CPT | Moderate | Excision Or Destruction, Open, Intra-Abdominal, Primary Or Secondary Tumor(S) Or Cyst(S), Sum Of The Maximum Length Of Tumor(S) Or Cyst(S); 5 Cm Or Less |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49186. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49186 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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