CPT 49405 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 • AG - Primary physician • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49405 |
National average reimbursement for CPT 49405 by major payers:
$936.59
$1,173.85
$1,268.52
$1,404.97
| 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 49405 | ||||||
United | 49405 | $2061.07 | 1700105533 - ANNA AHN | 521874111 - UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP INC | NY | Internal Medicine Physician (207R00000X) |
United | 49405 | $1016.06 | 1093886939 - DARYL ISAACS | 133669582 - DARYL ISAACS | NY | Internal Medicine Physician (207R00000X) |
United | 49405 | $1150.87 | 1699074518 - LAURA CONTINETTI | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 49405 | $1278.74 | 1144777541 - LEANNE MCNABNEY | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 49405 | $1475.25 | 1477592418 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 49405 | $905.39 | 1356683874 - STEVEN TVERSKY | 582629795 | NY | Neurology Physician (2084N0400X) |
United | 49405 | $1648.87 | 1134342439 - GUILLERMO GALLARDO | 202502972 | NY | Ophthalmology Physician (207W00000X) |
United | 49405 | $677.82 | 1760905632 - CLAIRE SUTHERBY | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Nurse Specialist (364S00000X) |
United | 49405 | $905.39 | 1982959979 - RAJIV NARULA | 582629795 | NJ | Neurology Physician (2084N0400X) |
United | 49405 | $1145.50 | 1912620980 - NIDHI MEHTA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 49405 | $2061.07 | 1720021728 - PAUL BURKE | 521874111 - UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP INC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 49405 | $1161.89 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 49405 | $1244.97 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49405 | $1272.78 | 1588150825 - COLLIN MESSERLY | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | MN | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 49405 | $1676.47 | 1720021728 - PAUL BURKE | 521874111 - UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP INC | NY | Obstetrics & Gynecology Physician (207V00000X) |
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 49405 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49405 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 49405 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 |
|---|---|---|
| 49020-CPT | High | Drain Absc/Local Inflam Peritoneal |
| 49082-CPT | Moderate | Once Per Dos Abdominal Paracentesis (Diagnostic Or Therapeutic); W/O Imaging Guidance |
| 49083-CPT | Moderate | Once Per Dos Abdominal Paracentesis (Diagnostic Or Therapeutic); W/Imaging Guidance |
| 49405-CPT | Moderate | Image-Guided Fluid Collection Drainage By Catheter (E.G., Abscess, Hematoma, Seroma, Lymphocele, Cyst); Visceral (E.G., Kidney, Liver, Spleen, Lung/Mediastinum), Percutaneous |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49405 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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