What factors affect CPT 49320 fee schedules?

Key factors affecting fee schedules for CPT 49320 include Medicare & Medicaid rates (government-set), private insurance rates (negotiated), geographic location (costs higher in urban areas), and provider type (hospital vs. private practice).

CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, healthcare providers, and payers to describe medical, surgical, and diagnostic services. They are essential for billing and processing healthcare claims, ensuring consistency and clarity in communication about the services provided.

How can I find the cost of a medical procedure?

To find the cost of a specific medical procedure, you'll typically need the CPT code for that procedure and your location. Insurance plans also play a significant role, as negotiated rates can vary. For a specific lookup, you can use tools like Payerprice, which allows you to search for fee schedules based on CPT code and specific location.

Where can I look up specific CPT code pricing?

For specific CPT code pricing based on your location and potentially payer, you can use specialized tools. Payerprice offers a fee schedule lookup tool where you can enter a CPT code and specific location to find relevant pricing information. This is often more accurate for specific situations than general governmental resources.

Does insurance affect the price I pay?

Yes, insurance significantly affects the price you pay. Insurance companies negotiate discounted rates with healthcare providers, which are often lower than the provider's standard charges. Your out-of-pocket costs will depend on your specific plan's deductible, co-insurance, and co-payment amounts, as well as whether the provider is in-network.

Are prices the same for all providers?

No, prices are generally not the same for all providers, even for the same procedure. Costs can vary significantly based on factors such as the provider's location, their affiliation with a hospital or clinic, their specialty, and their negotiated rates with different insurance companies. Tools like Payerprice can help you compare prices based on specific CPT codes and locations.

CPT 49320 Fee Schedule

Q: What is the description for CPT code 49320?

CPT code 49320 describes 'Laparoscopy, Abdomen, Peritoneum, And Omentum, Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure)'. It is used for moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Last Verified: October 2026

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.

Laparoscopy Surgical Abdomen, Laparoscopy Surgical Abdomen Peritoneum And Omentum Diagnostic With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure)

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 59 - Distinct Procedural Service 51 - Multiple procedures
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 49320
Medicaid Fee Schedule	View Medicaid rates for 49320

National average reimbursement for CPT 49320 by major payers:

$403.43

$440.69

$489.18

$533.75

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CPT 49320

5 of 25 sample ratesHigher to lower in this preview

Sjv Management, LLC, South Jersey Vascular Surgery Center
Sjv Management, LLC
NJAmbulatory Surgical Clinic/CenterNPI 1861913220Tax ID 20-2273476
$10,609.00Published rate
Advanced Surgical Care Of Clearwater LLC
FLAmbulatory Surgical Clinic/CenterNPI 1154956928Tax ID 83-3698204
$5,354.00Published rate
Northwest Orthopaedic Specialists, P.S., The Orthopaedic Surgery Center
Northwest Orthopaedic Specialists, P.S.
WAAmbulatory Surgical Clinic/CenterNPI 1265401202Tax ID 91-1502837
$3,424.00Published rate
East Paris Surgical Center, LLC
East Paris Surgical Center LLC
MIAmbulatory Surgical Clinic/CenterNPI 1194798959Tax ID 42-1565886
$1,600.00Published rate
North Pinellas Surgery Center LLC
North Pinellas Surgery Center, LLC
FLAmbulatory Surgical Clinic/CenterNPI 1750333746Tax ID 59-3759228
$680.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 49320 vs. Other Surgical Procedures on the Digestive System Codes

The CPT 49320 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 49320 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	Exploratory Laparotomy Explor, Exploratory Laparotomy Exploratory Celiotomy Withorwithout Biopsy(S) (Separate Procedure) Explora Tory Laparotomy Exploratory Celiotomy With Or
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).
49322-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 49320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 49320 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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CPT 49320 Fee Schedule

Compare published rates across providers.

Sjv Management, LLC, South Jersey Vascular Surgery Center

Advanced Surgical Care Of Clearwater LLC

Northwest Orthopaedic Specialists, P.S., The Orthopaedic Surgery Center

East Paris Surgical Center, LLC

North Pinellas Surgery Center LLC