CPT 49250 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 |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49250 |
National average reimbursement for CPT 49250 by major payers:
$745.81
$779.25
$816.17
$970.57
| 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 49250 | ||||||
United | 49250 | $3952.00 | 1588656508 - SAINT THOMAS CAMPUS SURGICARE LP | 752959131 - (TN) SAINT THOMAS CAMPUS SURGICARE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $2010.00 | 1194323725 - MISSION SURGERY CENTER LLC | 853429411 - (TX) MISSION SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $1250.00 | 1346322187 - XRS LLC, COLUMBUS PAIN INSTITUTE | 201384877 - (IN) XRS LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $2475.00 | 1609206614 - HURST AMBULATORY SURGERY CENTER, LLC, PRECINCT AMBULATORY SURGERY CENTER, LLC | 463648821 - (TX) HURST AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $1172.00 | 1710924881 - GEORGIA DERMASURGERY CENTERS, INC. | 582495671 - (GA) GEORGIA DERMASURGERY CENTERS INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $3347.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $1186.00 | 1831125962 - APAC SURGICAL CENTER II, LLC, APAC SURGERY CENTER II LLC | 352100376 - (IN) APAC SURGICAL CENTER II LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $3305.00 | 1992497762 - SEATTLE SURGERY CENTER LLC | 882819593 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $2400.00 | 1366181778 - AXION SPINE OUTPATIENT SURGERY CENTER | 881709019 - (GA) AXION SPINE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $2703.00 | 1508304692 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $3800.00 | 1023370251 - O'CONNOR BUILDING SURGERY CENTER LLC | 455437708 - (CA) OCONNOR BUILDING SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $3500.00 | 1033373691 - THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER, LLC | 208037589 - (SC) THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $5310.00 | 1487610390 - SURGERY CENTER OF FAIRFIELD COUNTY LLC, HEALTHSOUTH SURGERY CENTER OF BRIDGEPORT, LLC | 201733152 - (CT) SURGERY CENTER OF FAIRFIELD COUNTY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $1358.00 | 1497068761 - CARNEGIE HILL ENDOSCOPY LLC | 270385539 - (NY) CARNEGIE HILL ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49250 | $1509.00 | 1780683797 - LOVELAND ENDOSCOPY CENTER, LLC, SKYLINE ENDOSCOPY CENTER | 421589159 - (CO) LOVELAND ENDOSCOPY CENTER LLC | CO | 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 49250 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49250 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 49250 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 |
|---|---|---|
| 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 |
| 49250-CPT | Moderate | Umbilectomy,Omphalectomy, Excis.Of Umbil |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49250 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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