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 |
| Medicare Fee Schedule | View Medicare rates for 49189 |
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 | $450.00 | 1578094462 - AMERICAN ACCESS CARE OF JACKSONVILLE ASC LLC, AZURA SURGERY CENTER JACKSONVILLE | 814635841 - (FL) AMERICAN ACCESS CARE OF JACKSONVILLE ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $504.00 | 1306503057 - PAIN CARE SURGERY OF LOUISVILLE, LLC | 844317137 - (KY) PAIN CARE SURGERY OF LOUISVILLE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $1416.00 | 1245233220 - NORTHRIDGE SURGERY CENTER, LP, NORTHRIDGE SURGERY CENTER | 690003768 - (TN) NORTHRIDGE SURGERY CENTER LP | TN | 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 | $1199.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $250.00 | 1003036310 - MIDWEST ENDOSCOPY CENTER LLC | 208292570 - (IL) MIDWEST ENDOSCOPY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $436.00 | 1841347143 - RUXTON SURGICENTER LLC | 522095835 - (MD) RUXTON SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $1300.00 | 1811936933 - MOORESVILLE HOSPITAL MANAGMENT ASSOCIATES INC, SURGICAL CENTER OF LAKE NORMAN | 592612221 - (NC) MOORESVILLE HOSPITAL MANAGEMENT ASSOCIATES, LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $874.00 | 1124086608 - LUTHERAN CAMPUS ASC LLC, THE SURGERY CENTER AT LUTHERAN | 20749532 - (CO) LUTHERAN CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $740.00 | 1801185665 - PERSEPOLIS GROUP LLC | 273653631 - (CA) PERSEPOLIS GROUP LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $555.00 | 1811300403 - SUMMIT SURGERY CENTER | 465701676 - (CO) SUMMIT SURGERY CENTER | CO | 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 | $1020.00 | 1245806876 - WICHITA UROLOGY SURGERY CENTER,LLC | 834482229 - (KS) WICHITA UROLOGY SURGERY CENTERLLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $3434.00 | 1356480099 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49189 | $1064.00 | 1538461348 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. D/B/A THE OUTPATIENT CENT | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | 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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