CPT 49323 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 • 78 - Return to OR - related procedure • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $627.52 Physician Fee Schedule |
National average reimbursement for CPT 49323 by major payers:
$819.47
$852.60
$871.46
$1,047.69
| 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 49323 | ||||||
United | 49323 | $1615.00 | 1043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER | 911954101 - (WA) SKIN SURGERY CENTER P. S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $3484.00 | 1578534459 - BOSTON OUT-PATIENT SURGICAL SUITES, LLC | 270050256 - (MA) BOSTON OUT-PATIENT SURGICAL SUITES, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $1636.00 | 1265455463 - THE ENDOSCOPY CENTER AT BEL AIR | 470863243 - (MD) THE ENDOSCOPY CENTER AT BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $1030.00 | 1558451583 - LIPPY SURGERY CENTER LLC | 205293709 - (OH) LIPPY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $4169.00 | 1487620472 - RIVER ROAD SURGERY CENTER LLC | 931273946 - (OR) RIVER ROAD SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $5354.00 | 1548217128 - GULFSHORE ENDOSCOPY CENTER LLC | 650615196 - (FL) GULFSHORE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $5040.00 | 1962423574 - FULLERTON SURGICAL CENTER, LP, FULLERTON SURGICAL CENTER | 470927394 - (CA) FULLERTON SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $3850.00 | 1396120168 - STAMFORD ASC LLC | 465569848 - (CT) STAMFORD ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $5249.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $1581.00 | 1043283294 - THE HUTCHINSON OPHTHALMOLOGY ASC LLC, SURGERY CENTER OF SOUTH CENTRAL KANSAS | 621822845 - (KS) THE HUTCHINSON OPHTHALMOLOGY ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $2499.00 | 1083754352 - MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA, MERCY PHILADELPHIA HOSPITAL SHORT PROCEDURE UNIT | 231352191 - (PA) MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $5433.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $865.00 | 1306892609 - THE CLEARWATER ORTHOPAEDIC ASC LLC, C MED AMBULATORY SURGERY CENTER | 331011433 - (FL) THE CLEARWATER ORTHOPAEDIC ASS | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $6506.00 | 1891175188 - PHOENIX SPINE GOODYEAR ASC, LLC, PHOENIX SPINE SURGERY CENTER | 562311366 - (AZ) PHOENIX SPINE GOODYEAR, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49323 | $6506.00 | 1740371665 - SUMMIT SURGICAL ASSOCIATES LLC, SUMMIT SURGICAL CENTER | 954810282 - (CA) SUMMIT SURGICAL | 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 49323 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49323 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 49323 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 |
|---|---|---|
| 49321-CPT | Moderate | Laparoscopy, Surgical, Abdomen; With Biopsy (Single Or Multiple) |
| 49322-CPT | Moderate | Laparoscopy, Surgical; With Aspiration Of Cavity/Cyst (Eg, Ovarian Cyst) (Single/Multiple) |
| 49323-CPT | Moderate | Laparoscopy, Surgical; W Drainage Of Lymphocele To Peritoneal Cavity |
| 49324-CPT | Moderate | Laparoscopy, Surgical; Withh Biopsy (Single Or Multiple) With Insertion Of Tunneled Intraperitoneal Catheter |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49323. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49323 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 49323) and we'll show you how you compare in 15 minutes or less.