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 |
| CMS | $823.87 Physician Fee Schedule |
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 | $1447.28 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49405 | $677.82 | 1811375207 - KEVIN HENDRICKSON | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 49405 | $1244.97 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49405 | $677.82 | 1871047142 - MICHELLE SPENCE | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 49405 | $1475.25 | 1447264759 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Geriatric Medicine (Internal Medicine) Physician (207RG0300X) |
United | 49405 | $1475.25 | 1942576871 - SHALONDA NEWCOMB | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 49405 | $1475.25 | 1578527263 - EDWARD MOORE | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 49405 | $1475.25 | 1477592418 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 49405 | $677.82 | 1508855651 - TERRY SWEATT | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 49405 | $1244.97 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49405 | $1475.25 | 1679502777 - EVAN SPECK | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 49405 | $677.82 | 1336541275 - WILLIAM SALINAS | 350593390 - DEACONESS HOSPITAL INC | FL | Certified Registered Nurse Anesthetist (367500000X) |
United | 49405 | $1475.25 | 1821397407 - WILLIAM CHO | 350593390 - DEACONESS HOSPITAL INC | IN | Internal Medicine Physician (207R00000X) |
United | 49405 | $677.82 | 1760905632 - CLAIRE SUTHERBY | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Nurse Specialist (364S00000X) |
United | 49405 | $1743.71 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
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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