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See a sample rate comparisonCPT 49215 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.
Excision Of Presacralor Sacrococcygeal
| 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 62 - Co-Surgeons 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49215 |
| Medicaid Fee Schedule | View Medicaid rates for 49215 |
National average reimbursement for CPT 49215 by major payers:
$2,828.21
$2,937.67
$3,105.53
$3,511.37
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CPT 49215
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$9,124.00Published rateFlorham Park Endoscopy Asc LLC, Florham Park Endoscopy Center
Florham Park Endoscopy Center, LLC
$1,042.00Published rateRegency Surgery Center, LLC
Regency Surgery Center LLC
$744.00Published rateThomasville Surgery Center, Inc.
Thomasville Surgery Center Inc
$400.00Published rateSkin Cancer Treatment Center, L.L.C.
Skin Cancer Treatment Center LLC
$147.00Published rate
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See a sample payer proposalCPT 49215 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49215 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 49215 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 |
|---|---|---|
| 49215-CPT | High | Excision Of Presacralor Sacrococcygeal |
| 49320-CPT | Moderate | Laparoscopy Surgical Abdomen, Laparoscopy Surgical Abdomen Peritoneum And Omentum Diagnostic With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
| 49321-CPT | Moderate | Scope Surgery Of Abdomen, Abdominal Surgery Aided By A Scope (Laparoscopy). This Surgery May Involve Taking Tissue Samples For Testing (Biopsy) Draining A Cyst (Fluid Pocket) Or Implanting A Thin Tube (Catheter) Or Support Device (Stent). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49215 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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