CPT 49402 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 51 - Multiple procedures • 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| CMS | $837.45 Physician Fee Schedule |
National average reimbursement for CPT 49402 by major payers:
$1,070.83
$1,137.42
$1,179.88
$1,406.03
| 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 49402 | ||||||
United | 49402 | $1550.00 | 1730789231 - ZEO SURGICAL CENTER LLC, LENZA SURGICAL CENTER | 853310734 - (TX) ZEO SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $2100.00 | 1932136389 - SURGERY CENTER AT 900 N MICHIGAN AVE LLC | 364234488 - (IL) SURGERY CENTER AT 900 N MICHIGAN AVE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1500.00 | 1669621496 - CPM SURGERY CENTER 3, LLC | 263297851 - (GA) CPM SURGERY CENTER 3 LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $619.00 | 1477633071 - SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC, SURGERY CENTER | 351938206 - (IN) SURGERY CENTER OF EYE SPECIALISTS OF INDIANA PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3629.00 | 1407981327 - ARIA HEALTH TORRESDALE -SPU | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $2924.00 | 1275281370 - MASS GENERAL BRIGHAM AMSURG INC. | 854372153 - (NH) MASS GENERAL BRIGHAM INCORPORATED | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $6632.00 | 1396342838 - LEXINGTON HEALTH INC, LMC IRMO ASC | 852276567 - LEXINGTON HEALTH INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $6310.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1813.00 | 1770951915 - TRI-COUNTY VASCULAR CARE, LLC | 473091752 - (CA) TRICOUNTY VASCULAR CARE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3347.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $2175.00 | 1316350275 - ORCHARD SURGICAL CENTER, LLC, ORCHARD SURGICAL CENTER | 465568612 - (NH) ORCHARD SURGICAL CENTER, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3926.00 | 1205030731 - PIERCE STREET SAME DAY SURGERY, LC, PIERCE STREET SAME DAY SURGERY, LC | 205895205 - (IA) PIERCE STREET SAME DAY SURGERY | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1610.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 825301397 - (VA) VIRGINIA ENT SURGERY CENTER INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3500.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1906.00 | 1770588584 - PHYSICIANS SURGERY CENTER LLC, NATIONAL SPINE & ORTHO SURGERY CENTER OF FT. MYERS | 592924183 - (FL) PHYSICIANS SURGERY CENTER LLC | FL | 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 49402 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49402 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 49402 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 |
|---|---|---|
| 49400-CPT | Low | Pneumoperitoneum; Initial |
| 49402-CPT | High | Removal Of Peritoneal Foreign Body From Peritoneal Cavity |
| 49406-CPT | Moderate | Image-Guided Fluid Collection Drainage By Catheter (E.G., Abscess, Hematoma, Seroma, Lymphocele, Cyst); Peritoneal Or Retroperitoneal, Percutaneous |
| 49418-CPT | High | Insertion Of Tunneled Intraperitoneal Catheter (Eg Dialysis Intraperitoneal Chemotherapahy Instillation Management Of Ascites) Complete Procedure Including Imaging Guidance Catheter Placement Contrast Injection When Performed And Radiological Supervision And Interpretation Percutaneous |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49402 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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