CPT 49421 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49421 |
National average reimbursement for CPT 49421 by major payers:
$331.19
$357.58
$356.74
$406.57
| 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 49421 | ||||||
United | 49421 | $2175.00 | 1831368356 - VERMONT EYE SURGERY & LASER CENTER | 204872230 - (VT) VERMONT EYE SURGERY & LASER CENTER, LLC 401(K) PLAN | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $3400.00 | 1245862002 - QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC, QUINCY MEDICAL GROUP SURGERY CENTER | 371206525 - QUINCY PHYSICIANS & SURGEONS CLINIC S.C. D/B/A QUINCY MEDICAL GROUP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $3458.00 | 1639553779 - UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC., M HEALTH CLINICS AND SURGERY CENTER | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $3422.00 | 1639452444 - CHILDREN'S AMBULATORY SURGERY CENTER OF NEW JERSEY, LLC | 271462884 - (NJ) CHILDRENS AMBULATORY SURGERY CENTER OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $1601.00 | 1174999700 - ADVANCED SURGERY CENTER OF CENTRAL IOWA, LLC | 472673565 - (IA) ADVANCED SURGERY CENTER OF CENTRAL IOWA LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $2974.00 | 1730571118 - MEDSTAR MEDICAL GROUP | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $1792.00 | 1033105960 - SURGERY CENTER OF OAK RIDGE, LLC, ADVANCED FAMILY SURGERY CENTER | 621801416 - (TN) ADVANCED FAMILY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $7147.00 | 1649482449 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $1985.00 | 1962959296 - RUSH-COPLEY SURGICENTER, LLC, CASTLE SURGICENTER | 384012268 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $395.73 | 1982810990 - JOSEPH JENKINS | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 49421 | $1433.00 | 1396823381 - HEAD AND NECK SURGERY ASSOCIATES, PSC, CENTER FOR SURGICAL CARE | 610938951 - HEAD & NECK SURGERY ASSOC., PSC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $2310.00 | 1003369216 - CRESTVIEW HILLS SURGERY CENTER, PLLC, ICAN | 273003180 - (KY) MICHAEL FLETCHER MD PLLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $1200.00 | 1588839609 - RIVERWALK AMBULATORY SURGERY CENTER LLC | 260594903 - (FL) RIVERWALK AMBULATORY SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $2300.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49421 | $1929.00 | 1518972322 - CASA COLINA SURGERY CENTER LLC | 300156851 - (CA) CASA COLINA SURGERY CENTER L.P. | CA | 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 49421 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49421 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 49421 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 |
|---|---|---|
| 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 |
| 49419-CPT | Moderate | Insertion Of Tunneled Intraperitoneal Catheter, With Subcutaneous Port (Ie, Totally Implantable) (Revision 2011) |
| 49421-CPT | Moderate | Insertion Of Tunneled Intraperitoneal Catheter For Dialysis, Open (Revision 2011) |
| 49422-CPT | Moderate | Removal Of Tunneled Intraperitoneal Catheter (Revision 2011) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49421. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49421 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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