CPT 49190 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 49190 |
National average reimbursement for CPT 49190 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 49190 | ||||||
United | 49190 | $300.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $1416.00 | 1487693123 - CLARKSVILLE SURGERY CENTER LLC | 621752518 - (TN) CLARKSVILLE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $590.00 | 1487651956 - TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC, TRI-STATE DIGESTIVE DISORDER CENTER | 611192347 - (KY) TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $1274.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $600.00 | 1235132481 - CYPRESS AMBULATORY SURGERY CENTER | 770568944 - (CA) CYPRESS AMBULATORY SURGERY CEN | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $324.00 | 1801073648 - ELITE ENDOSCOPY LLC | 202722461 - (NV) ELITE ENDOSCOPY LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $371.00 | 1508360181 - NEPHROLOGY VASCULAR LAB OF CENTRAL ALABAMA ASC LLC | 815281505 - (AL) NEPHROLOGY VASCULAR LAB OF CENTRAL ALABAMA ASC LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $2172.00 | 1548238140 - DENTON SURGICARE PARTNERS LTD, BAYLOR SCOTT & WHITE SURGICARE - DENTON | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $578.00 | 1437736071 - SCENT ASC OPPORTUNITY FUND LLC, SCENT SURGICAL CENTER | 862520870 - (SC) SCENT ASC OPPORTUNITY FUND LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $283.00 | 1922316835 - INDEPENDENT SURGERY CENTER LLC | 272764590 - (WI) INDEPENDENT SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $880.00 | 1225308257 - CROWN VALLEY OUTPATIENT SURGICAL CENTER LLC, MISSION ENDOSCOPY CENTER | 454125214 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $2575.00 | 1154785848 - PROSPECT CCMC, LLC | 811507712 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $410.00 | 1679804355 - LONESTAR AMBULATORY SURGICAL CENTER | 263806076 - (TX) LONESTAR AMBULATORY SURGICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $1367.00 | 1457891426 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE CENTER FOR OUTPATIENT SPINE AND JOINT SURGERY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49190 | $840.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | 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 49190 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49190 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 49190 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 |
|---|---|---|
| 49190-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); Greater Than 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 49190. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49190 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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