CPT 49205 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 22 - Increased Procedural Services • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 49205 by major payers:
$2,124.18
$2,034.66
$1,902.67
$2,653.75
| 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 49205 | ||||||
United | 49205 | $20777.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $6365.00 | 1881013142 - ADVANCED SURGERY CENTER OF TAMPA, LLC | 463891843 - (FL) ADVANCED SURGERY CENTER OF TAMPA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $9182.00 | 1518344043 - MEMORIAL HERMANN SURGERY CENTER KIRBY, LLC, MEMORIAL HERMANN SURGERY CENTER KIRBY GLEN | 364801162 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $1040.00 | 1265542849 - GREAT LAKES EYE SURGERY CENTER LLC | 205428461 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $6365.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $1804.00 | 1235118043 - AUGUSTA RETINA LASER SURGICARE | 582398710 - (GA) AUGUSTA RETINA LASER SURGICARE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $1700.00 | 1336208081 - ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH | 593740436 - (FL) ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $1697.00 | 1801457478 - DIALYSIS ACCESS CENTER, LLC | 834488032 - (OH) DIALYSIS ACCESS CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $2860.00 | 1659505857 - HASBROUCK HEIGHTS SURGERY CENTER, LLC | 264379508 - (NJ) HASBROUCK HEIGHTS SURGERY CENT | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $7351.00 | 1306905815 - UAS MANAGEMENT, INC., UNIVERSITY SURGERY CENTER | 611845381 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $3200.00 | 1619487782 - UCH VASCULAR ACCESS ASC LLC | 820975009 - (TN) UCH VASCULAR ACCESS ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $2429.00 | 1700843208 - FAYETTEVILLE AMBULATORY SURGERY CENTER LIMITED PARTNERSHIP, FAYETTEVILLE AMBULATORY SURGERY CENTER | 561754482 - (NC) FAYETTEVILLE AMBULATORY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $3451.00 | 1275281370 - MASS GENERAL BRIGHAM AMSURG INC. | 854372153 - (NH) MASS GENERAL BRIGHAM INCORPORATED | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $5012.00 | 1295381572 - SOUTH SUBURBAN SURGICAL SUITES, LLC, SOUTH SUBURBAN SURGICAL SUITES | 842207819 - (IN) SOUTH SUBURBAN SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49205 | $6087.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | 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 49205 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49205 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 49205 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 |
|---|---|---|
| 49185-CPT | High | Sclerotherapy Of A Fluid Collection (Eg Lymphocele Cyst Or Seroma) Percutaneous Including Contrast Injection(S) Sclerosant Injection(S) Diagnostic Study Imaging Guidance (Eg Ultrasound Fluoroscopy) And Radiological Supervision And Interpretation When Performed. |
| 49203-CPT | High | Excision Or Destruction, Open, Intra-Abdominal Tumors, Cysts Or Endometriomas, 1 Or More Peritoneal, Mesenteric, Or Retroperitoneal Primary Or Secondary Tumors; Largest Tumor 5 Cm Diameter Or Less |
| 49204-CPT | High | Excision Or Destruction Open Intra-Abdominal Tumors Cysts Or Endometriomas 1 Or More Peritoneal Mesenteric Or Retroperitoneal Primary Or Secondary Tumors;Largest Tumor 5.1-10.0 Cm Diameter |
| 49205-CPT | High | Excision Or Destruction Open Intra-Abdominal Tumors Cysts Or Endometriomas 1 Or More Peritoneal Mesenteric Or Retroperitoneal Primary Or Secondary Tumors;Largest Tumor Greater Than 10.0 Cm Diameter |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49205 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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