CPT 49321 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 • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| CMS | $338.02 Physician Fee Schedule |
National average reimbursement for CPT 49321 by major payers:
$437.09
$463.09
$513.68
$573.58
| 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 49321 | ||||||
United | 49321 | $784.00 | 1285673186 - BERKSHIRE COSMETIC & RECONSTRUCTIVE SURGERY CENTER INC. | 43421240 - (MA) BERKSHIRE COSMETIC RECONSTRUCTIVE SURGERY CENTER INC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $858.00 | 1649376757 - ADS HEALTHCARE LLC, ADS AMBULATORY SURGERY CENTER | 481207671 - (KS) ADS HEALTHCARE LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $2862.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $2142.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $6506.00 | 1679504690 - SANTA CLARITA SURGERY CENTER LP | 202829660 - (CA) SANTA CLARITA SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $954.00 | 1205454626 - EYE SURGERY CENTER OF WISCONSIN, LLC | 833779684 - (WI) EYE SURGERY CENTER OF WISCONSIN, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $1500.00 | 1033113402 - NORTHWEST FLORIDA SURGICAL CENTER, LLC, NORTH FLORIDA SURGERY CENTER | 593081991 - (FL) NORTHWEST FLORIDA SURGICAL CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $1107.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $1090.00 | 1760454557 - PHOENIX OPHTHALMOLOGY ASC LLC, ARIZONA OPHTHALMIC OUTPATIENT SURGERY | 621726788 - (AZ) PHOENIX OPHTHALMOLOGY ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $5433.00 | 1477615284 - ROCKY MOUNTAIN ENDOSCOPY CENTERS, LLC | 841403147 - (CO) ROCKY MOUNTAIN ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $3309.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $1567.00 | 1821067554 - OLD TOWN ENDOSCOPY CENTER LLC, DIGESTIVE HEALTH CENTER OF DALLAS | 752774028 - (TX) OLD TOWN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $1957.00 | 1225042575 - PACIFIC SURGERY CENTER LLC | 931265552 - PACIFIC SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $5249.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49321 | $2026.00 | 1407932619 - PACIFIC EYE INSTITUTE A MEDICAL GROUP INC, PACIFIC EYE INSTITUTE AMBULATORY SURGERY CTR | 330303507 - (CA) PACIFIC EYE INSTITUTE MEDICAL CORPORATION | CA | 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 49321 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49321 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 49321 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 |
| 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 49321. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49321 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 49321) and we'll show you how you compare in 15 minutes or less.