CPT 49189 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 | $2,269.75 Physician Fee Schedule |
National average reimbursement for CPT 49189 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 49189 | ||||||
United | 49189 | $4300.00 | 1790876431 - MAIN LINE SPINE SURGERY CENTER, LLC | 202547795 - (PA) MAIN LINE SPINE SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $1407.00 | 1154840064 - SOUTHHEALTH ASC, LLC, EDINA SPECIALTY SURGERY CENTER | 822364607 - (MN) SOUTHHEALTH ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $775.00 | 1306242466 - AMSC, LLC, DOWNTOWN BRONX ASC | 201927382 - (NY) AMSC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $410.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $550.00 | 1225023021 - ARC OF GEORGIA, LLC, PREMIER SURGERY CENTER | 621746313 - (GA) ARC OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $105.00 | 1285333914 - ARIZONA SURGICAL SPECIALISTS CENTER, LLC, ARIZONA SURGICAL SPECIALISTS CENTER, LLC - SCOTTSDALE | 760737449 - (AZ) ARIZONA SURGICAL SPECIALISTS CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $734.00 | 1205881935 - HERITAGE EYE CENTER LC, HERITAGE SURGERY CENTER LC | 752409758 - (TX) HERITAGE EYE CENTER LC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $582.00 | 1093053381 - NORTH COUNTRY EC LLC, NORTHEASTERN NEW YORK SURGICAL CENTER | 453715451 - (NY) NORTH COUNTRY EC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $523.00 | 1518070879 - EHLERS EYE SURGERY LLC | 270079770 - (WA) EHLERS EYE SURGERY LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $677.00 | 1508818634 - MONTEREY BAY ENDOSCOPY CENTER LLC | 770324855 - (CA) MONTEREY BAY ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $464.00 | 1497751747 - MID-ATLANTIC ENDOSCOPY CENTER, LLC, MID-ATLANTIC GASTROINTESTINAL CENTER II | 233096335 - (DE) MIDATLANTIC ENDOSCOPY CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $6068.00 | 1841295425 - CROSS TIMBERS SURGERY CENTER, LLC, NORTH TEXAS GI CENTER | 752862780 - (TX) CROSS TIMBERS SURGERY CENTER, LP DBA NORTH TEXAS GI CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $80.00 | 1093921298 - INDIANA SKIN CANCER AMBULATORY SURGICAL CENTER LLC | 260149227 - (IN) INDIANA SKIN CANCER AMBULATORY SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $1608.00 | 1700807617 - ENDOSCOPY CENTER OF THE ROCKIES LLC, ENDOSCOPY CENTER OF THE ROCKIES LAFAYETTE | 841562782 - (CO) ENDOSCOPY CENTER OF THE ROCKIES LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $400.00 | 1194718940 - 20-20 SURGERY CENTER LLC | 331066427 - (PA) 2020 SURGERY CENTER LLC | PA | 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 49189 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49189 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 49189 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 |
|---|---|---|
| 49189-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); 20.1 To 30 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49189. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49189 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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