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See a sample rate comparisonCPT 49189 Fee Schedule
Last Verified: October 2026
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.
Opn Exc/Dst Ntra-Abd 20.1-30, Excision Or Destruction Open Intra-Abdominal (Ie Peritoneal Mesenteric Retroperitoneal) Primary Or Secondary Tumor(S) Or Cyst(S) Sum Of The Maximum Length Of Tumor(S) Or Cyst(S); 20.1 To 30 Cm
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49189 |
| Medicaid Fee Schedule | View Medicaid rates for 49189 |
National average reimbursement for CPT 49189 by major payers:
$3,364.10
$4,750.89
$1,222.86
$3,529.84
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CPT 49189
5 of 25 sample ratesHigher to lower in this preview
Cross Timbers Surgery Center, LLC, North Texas Gi Center
Cross Timbers Surgery Center, Lp Dba North Texas Gi Center
$6,068.00Published rateNorthridge Surgery Center, Lp, Northridge Surgery Center
Northridge Surgery Center Lp
$1,416.00Published rateWichita Urology Surgery Center,LLC
Wichita Urology Surgery Centerllc
$1,020.00Published ratePain Care Surgery Of Louisville, LLC
Pain Care Surgery Of Louisville LLC
$504.00Published rateNorthpointe Surgical Center, LLC
Northpointe Surgical Center LLC
$250.00Published rate
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See a sample payer proposalCPT 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 | High | Opn Exc/Dst Ntra-Abd 20.1-30, Excision Or Destruction Open Intra-Abdominal (Ie Peritoneal Mesenteric Retroperitoneal) 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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