CPT 49320 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 • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $324.44 Physician Fee Schedule |
National average reimbursement for CPT 49320 by major payers:
$403.43
$440.69
$489.18
$546.74
| 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 49320 | ||||||
United | 49320 | $1624.00 | 1821064031 - PIEDMONT DAY SURGERY CENTER INC | 541514162 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $3712.00 | 1710768783 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC, ATLAS SURGERY CENTER | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $5400.00 | 1760440515 - SIERRA ENDOSCOPY CENTER, LLC | 680482297 - (CA) SIERRA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $3100.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $4601.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $1600.00 | 1194798959 - EAST PARIS SURGICAL CENTER, LLC | 421565886 - (MI) EAST PARIS SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $5745.00 | 1497776553 - ALPINE SURGERY CENTER LLC | 204038061 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $6074.00 | 1326097981 - FREDERICKSBURG AMBULATORY SURGERY CENTER, LLC | 562322548 - (VA) FREDERICKSBURG AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $4603.00 | 1710924899 - DMG SURGICAL CENTER LLC, SURGICAL CENTER OF DUPAGE MEDICAL GROUP | 371474161 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $2500.00 | 1669427043 - VANCOUVER EYE CARE PS | 910913651 - (WA) VANCOUVER EYE CARE, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $731.00 | 1215919113 - VISION INSTITUTE OF MICHIGAN SURGERY CENTER PC, SURGERY CENTER OF MICHIGAN | 382945641 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $5354.00 | 1841395894 - FRANKLIN ENDOSCOPY CENTER, LLC, FRANKLIN ENDOSCOPY CENTER | 383730672 - (TN) FRANKLIN ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $1266.00 | 1871052712 - KURESMART PAIN MANAGEMENT SURGERY CENTER-COLUMBIA LLC, CLEARWAY SURGERY CENTER OF COLUMBIA | 834028893 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCOLUMBIA LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $5354.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49320 | $1968.00 | 1295948339 - WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC | 463956703 - (NC) WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER INC | NC | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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 | Laparotomy/Celiotomy Exploratory |
| 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 |
| 49320-CPT | Moderate | Laparoscopy, Abdomen, Peritoneum, And Omentum, Diagnostic, With Or Without Collection Of Specimen(S) By Brushing Or Washing (Separate Procedure) |
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 49320) and we'll show you how you compare in 15 minutes or less.