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 |
| Medicare Fee Schedule | View Medicare rates for 49402 |
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 | $1505.00 | 1194291401 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3997.00 | 1427044452 - THE SURGERY CENTER AT SELF MEMORIAL HOSPITAL, LLC, SURGERY CENTER OF THE LAKELANDS | 571087792 - (SC) THE SURGERY CENTER AT SELF MEM | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1214.00 | 1134366370 - CENTER OF SURGICAL EXCELLENCE, COSE ANESTHESIA BILLING | 202807874 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1644.00 | 1609915230 - PACIFIC SURGERY CENTER | 330113109 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $643.00 | 1508054818 - CUMMINS WOMENS HEALTHCARE LLC, ELIZABETH CUMMINS MD | 522110421 - (OH) CUMMINS WOMENS HEALTHCARE, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3976.00 | 1295176139 - LOWCOUNTRY AMBULATORY CENTER, LLC | 274109893 - (SC) LOWCOUNTRY AMBULATORY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1431.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $3188.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $600.00 | 1689682247 - ST. PETERSBURG ENDOSCOPY CENTER LLC | 203046109 - (FL) ST. PETERSBURG ENDOSCOPY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $383.00 | 1629262811 - PREMIER ENDOSCOPY CENTER LLC | 205055187 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1234.00 | 1497895361 - MADHU K. KRIS M.D., MERCED AMBULATORY ENDOSCOPY CENTER | 770095000 - (CA) MADHU K KRIS MD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1258.00 | 1629152053 - ISLAND EYE SURGICENTER LLC | 113486191 - (NY) ISLAND EYE SURGICENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49402 | $1800.00 | 1689635757 - ATLANTICARE SURGERY CENTER LLC | 223491867 | NJ | 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 | $1400.00 | 1972535292 - CATARACT AND LASER SURGERY CENTER, THE OPHTHALMOLOGY & SURGICAL INSTITUTE OF CENTRAL PA | 201308496 - (PA) CATARACT AND LASER SURGERY CENTER | PA | 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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