CPT 49255 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $777.61 Physician Fee Schedule |
National average reimbursement for CPT 49255 by major payers:
$976.30
$1,045.16
$1,089.39
$1,296.13
| 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 49255 | ||||||
United | 49255 | $850.00 | 1881728590 - SYSTEM OPTICS LLC | 341572960 - (OH) SYSTEM OPTICS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $850.00 | 1407095359 - PAIN CARE CENTER OF GEORGIA LLC | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2859.00 | 1225579295 - SANTA BARBARA OUTPATIENT SURGERY CENTERS LLC, SANTA BARBARA SURGERY CENTER | 371846158 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2388.00 | 1992992994 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2353.00 | 1831180272 - ADVANCED ENDOSCOPY CENTER LLC | 861083384 - (MO) ADVANCED ENDOSCOPY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2353.00 | 1083176309 - SPICEWOOD SURGERY CENTER LLC, SPICEWOOD SURGERY CENTER | 834343089 - (TX) SPICEWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $3608.00 | 1710231642 - ADVANCED REGIONAL SURGERY CENTER, LLC | 461072979 - (IN) ADVANCED REGIONAL SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $3427.00 | 1558328096 - NEWPORT BEACH ENDOSCOPY CENTER, LLC | 770368744 - (CA) NEWPORT BEACH ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $5625.00 | 1245575919 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC, MEMORIALCARE SURGICAL CENTER LAGUNA WOODS | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2353.00 | 1063947422 - SILVER CROSS AMBULATORY SURGERY CENTER, LLC, SILVER CROSS SURGERY CENTER | 371852055 - (IL) SILVER CROSS AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $2903.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $1000.00 | 1508846411 - FIRST STATE SURGERY CENTER, LLC | 510402966 - (DE) FIRST STATE SURGERY CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $485.00 | 1750333746 - NORTH PINELLAS SURGERY CENTER LLC | 593759228 - (FL) NORTH PINELLAS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $866.00 | 1558748996 - NEMG GASTROENTEROLOGY LLC, FAIRFIELD COUNTY ENDOSCOPY CENTER | 473578382 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49255 | $1785.00 | 1861492530 - GRANTS PASS SURGERY CENTER, LLC | 931237063 - (OR) GRANTS PASS SURGERY CENTER, LLC | OR | 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 49255 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49255 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 49255 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 |
|---|---|---|
| 49000-CPT | Moderate | Laparotomy/Celiotomy Exploratory |
| 49255-CPT | Moderate | Omentectomy/Epiploectomy |
| 49320-CPT | Moderate | Laparoscopy, Abdomen, Peritoneum, And Omentum, Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
| 49321-CPT | Moderate | Laparoscopy, Surgical, Abdomen; With Biopsy (Single Or Multiple) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49255 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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