CPT 49187 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 |
| CMS | $1,632.85 Physician Fee Schedule |
National average reimbursement for CPT 49187 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 49187 | ||||||
United | 49187 | $550.00 | 1386749943 - QUAIL SURGICAL AND PAIN MANAGEMENT CENTER, LLC | 880391609 - (NV) QUAIL SURGICAL & PAIN MANAGEMENT CENTER, LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $533.00 | 1801094669 - CLEVELAND EYE AND LASER SURGERY CENTER LLC | 205487161 - (OH) CLEVELAND EYE & LASER SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $2732.00 | 1710910922 - SURGERY CENTER OF INDEPENDENCE LP | 200670748 - (MO) SURGERY CENTER OF INDEPENDENCE LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $775.00 | 1679531610 - BOSTON UNIVERSITY EYE ASSOCIATES, INC., BOSTON UNIVERSITY EYE ASSOCIATES SURGERY & LASER CENTER | 43137333 - (MA) BOSTON UNIVERSITY EYE ASSOCIATES INC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $1216.00 | 1942292545 - CAPITAL REGION AMBULATORY SURGERY CENTER, L.L.C. | 141819902 - (NY) CAPITAL REGION AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $1274.00 | 1699284018 - ONYX & PEARL SURGICAL SUITES LLC | 821183739 - (OH) ONYX & PEARL SURGICAL SUITES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $862.00 | 1396709077 - RMC SURGERY CENTER, LLC, RMC SURGERY CENTER | 330937423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $290.00 | 1770599136 - RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC, RADIANCE SURGERY CENTER | 510465402 - (PA) RADIANCE, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $862.00 | 1083686208 - WICHITA ORTHOPAEDIC ASC LLC, SURGERY CENTER OF KANSAS | 621659908 - (KS) WICHITA ORTHOPAEDIC ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $654.00 | 1679544050 - TUSCALOOSA SURGICAL CENTER LP, TUSCALOOSA SUR | 630974161 - (AL) TUSCALOOSA SURGICAL CENTER LP | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $637.00 | 1295720530 - ELMIRA ASC LLC | 161549510 - (NY) ELMIRA ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $770.00 | 1093960395 - GRAYSTONE EYE SURGERY CENTER LLC | 205740206 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $2732.00 | 1912993833 - SURGICENTER OF KANSAS CITY, LLC | 431828920 - (MO) SURGICENTER OF KANSAS CITY, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $995.00 | 1538608138 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49187 | $1192.00 | 1366864514 - GREAT SOUTH BAY ENDOSCOPY CENTER, LLC | 463055867 - (NY) GREAT SOUTH BAY ENDOSCOPY CENTER 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 49187 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49187 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 49187 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 |
|---|---|---|
| 49187-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); 5.1 To 10 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49187. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49187 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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