CPT 49407 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
| CMS | $705.48 Physician Fee Schedule |
National average reimbursement for CPT 49407 by major payers:
$867.97
$976.66
$1,027.33
$1,189.71
| 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 49407 | ||||||
United | 49407 | $934.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $742.00 | 1649957168 - BLUE ASH ENDOSCOPY CENTER, LLC | 931613837 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $600.00 | 1033734728 - ORANGE COUNTY SURGICAL CENTER | 851774434 - (CA) ORANGE COUNTY SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $905.00 | 1003015843 - NORTHBAY PHYSICIAN'S SURGERY CENTER, L.L.C. | 203502901 - (CA) NORTHBAY PHYSICIANS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1315.00 | 1376228361 - SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | 923802390 - (OH) SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1297.00 | 1518323435 - SOUTHTOWNS SURGERY CENTER LLC | 464742028 - (NY) SOUTHTOWNS SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1233.00 | 1649317660 - ORTHOVIRGINIA, INC | 540885859 - (VA) ORTHOVIRGINIA, INC. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $633.00 | 1568445062 - EYE SURGERY & LASER CENTER OF WISCONSIN LLC | 461222222 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1276.00 | 1154387710 - WARNER PARK SURGERY CENTER LLC, CENTER FOR ADVANCED SURGERY | 752824260 - (AZ) WARNER PARK SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $480.00 | 1649443367 - SKIN SURGERY CENTER OF VIRGINIA | 262319829 - (VA) SKIN SURGERY CENTER OF VIRGINIA | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1200.00 | 1023072824 - SOUTH JERSEY EYE PHYSICIANS, LLC, THE SURGICAL CENTER AT SOUTH JERSEY EYE PHYSICIANS, PA | 222116946 - (NJ) SOUTH JERSEY EYE PHYSICIANS, PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $822.00 | 1750529814 - WEST BRIDGEWATER MA ENDOSCOPY ASC LLC, COMMONWEALTH ENDOSCOPY CENTER | 261765306 - (MA) WEST BRIDGEWATER MA ENDOSCOPY ASC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $995.00 | 1518311141 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $1179.00 | 1629508387 - WELLINGTON ENDOSCOPY CENTER LLC | 813254698 - (FL) WELLINGTON ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49407 | $663.00 | 1710952841 - ANDOCHICK SURGICAL CENTER LLC, PHYSICIANS SURGERY CENTER OF FREDERICK | 522239166 - (MD) ANDOCHICK SURGICAL CENTER LLC | MD | 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 49407 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49407 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 49407 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 |
|---|---|---|
| 49406-CPT | Moderate | Image-Guided Fluid Collection Drainage By Catheter (E.G., Abscess, Hematoma, Seroma, Lymphocele, Cyst); Peritoneal Or Retroperitoneal, Percutaneous |
| 49407-CPT | Moderate | Image-Guided Fluid Collection Drainage By Catheter (Eg, Abscess, Hematoma, Seroma, Lymphocele, Cyst); Peritoneal Or Retroperitoneal, Transvaginal Or Transrectal |
| 49411-CPT | Moderate | Placement Of Interstitial Device(S) For Radiation Therapy Guidance (Eg, Fiducial Markers, Dosimeter), Percutaneous, Intra-Abdominal, Intra-Pelvic (Except Prostate), And/Or Retroperitoneum, Single Or Multiple |
| 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 49407. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49407 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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