CPT 49422 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 GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49422 |
National average reimbursement for CPT 49422 by major payers:
$350.62
$396.36
$415.08
$432.63
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 49422 | $750.71 | 1982292579 - GRACE YANOSICH | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Medical Physician Assistant (363AM0700X) |
United | 49422 | $769.35 | 1194871707 - MEGAN KELSEY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Endocrinology Physician (2080P0205X) |
United | 49422 | $804.33 | 1760772859 - LAUREN THAXTON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Obstetrics & Gynecology Physician (207V00000X) |
United | 49422 | $709.92 | 1770560617 - MARY SEAGRAVES | 270883714 - (CO) ROCKY MOUNTAIN VEIN INSTITUTE | CO | Surgery Physician (208600000X) |
United | 49422 | $3308.00 | 1255787867 - THE METROHEALTH SYSTEM, METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | 346004382 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49422 | $820.41 | 1881972800 - GENEVIEVE MOYER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | MO | Hematology & Oncology Physician (207RH0003X) |
United | 49422 | $426.64 | 1609018969 - THEA PRICE | 911780160 | FL | Surgery Physician (208600000X) |
United | 49422 | $804.33 | 1982022539 - SEAN PASCHALL | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CA | Anesthesiology Physician (207L00000X) |
United | 49422 | $373.01 | 1689917437 - MICHAEL WEINREICH | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | NY | Cardiovascular Disease Physician (207RC0000X) |
United | 49422 | $937.21 | 1700140829 - JASON RAPAPORT | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Anesthesiology Physician (207LP3000X) |
United | 49422 | $820.41 | 1922341874 - CAMERON GIBSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Trauma Surgery Physician (2086S0127X) |
United | 49422 | $804.33 | 1417311804 - HEATHER ROESLY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Emergency Medicine Physician (207P00000X) |
United | 49422 | $579.51 | 1215970926 - MATTHEW SWELSTAD | 840637098 - (CO) COLO WEST OTOLARYNGOLOGISTS | CO | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 49422 | $657.45 | 1891081071 - MAGDALENA DANCH | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Hospitalist Physician (208M00000X) |
United | 49422 | $804.33 | 1841802956 - ADAM CHARTRAND | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Anesthesiologist Assistant (367H00000X) |
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 49422 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49422 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 49422 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 |
|---|---|---|
| 49421-CPT | Moderate | Surgery To Embed Catheter, Surgery To Embed A Thin Tube (Catheter) Into The Tissues Or Under The Skin. The Catheter May Have A Sealable Opening (Port). Typically An Embedded Catheter Is Used For Dialysis Or To Deliver Medicines. |
| 49422-CPT | Moderate | Surgery To Remove Catheter, Surgery To Remove A Thin Tube (Catheter) That Had Been Surgically Embedded Under The Skin. |
| 49423-CPT | Moderate | Exchange Of Previously Placed, Exchange Of Previously Placed Abscess Or Cyst Drainagecatheter Under Radiological Guidance (Separateprocedure) |
| 49424-CPT | Low | Dye Injection For Assessment, Dye Injection Through An Existing Drainage Thin Tube (Catheter). The Dye Will Help Assess An Infection Or Pocket Of Fluid (Cyst). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49422. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49422 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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