CPT 49423 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 • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49423 |
National average reimbursement for CPT 49423 by major payers:
$634.40
$747.62
$833.99
$898.90
| 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 49423 | ||||||
United | 49423 | $455.85 | 1083073035 - LILLIAN SILVA | 350593390 - DEACONESS HOSPITAL INC | VA | Certified Registered Nurse Anesthetist (367500000X) |
United | 49423 | $874.95 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 49423 | $992.14 | 1821440801 - RAUL RAMIREZ VELAZQUEZ | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 49423 | $1687.35 | 1326508557 - BROOKE LEARNED | 112558775 - (NY) STONY BROOK INTERNISTS P C | NY | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
United | 49423 | $1586.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 49423 | $868.44 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 49423 | $520.88 | 1689932071 - YACHAO ZHANG | 823514422 - (NY) FOXHURST PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC | NY | Vascular & Interventional Radiology Physician (2085R0204X) |
United | 49423 | $455.85 | 1811377153 - THANHTAM NGUYEN | 350593390 - DEACONESS HOSPITAL INC | TX | Certified Registered Nurse Anesthetist (367500000X) |
United | 49423 | $985.00 | 1326609231 - NARENDRA BHATTARAI | 464249555 - (NY) GOUVERNEUR HOSPITAL | NY | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 49423 | $985.00 | 1184203663 - ZACHARY JOHANNESSON | 464249555 - (NY) GOUVERNEUR HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 49423 | $1181.78 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 49423 | $1222.09 | 1992211171 - REBECCA WOOLWEAVER | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Pediatrics Physician (208000000X) |
United | 49423 | $451.32 | 1689932071 - YACHAO ZHANG | 823514422 - (NY) FOXHURST PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC | NY | Vascular & Interventional Radiology Physician (2085R0204X) |
United | 49423 | $378.41 | 1912347030 - AMOL SHAH | 871275167 - (NJ) ESSEX DIGESTIVE HEALTHCARE PC | NJ | Gastroenterology Physician (207RG0100X) |
United | 49423 | $1827.48 | 1326508557 - BROOKE LEARNED | 112558775 - (NY) STONY BROOK INTERNISTS P C | NY | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
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 49423 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49423 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 49423 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 |
|---|---|---|
| 49422-CPT | Moderate | Removal Of Tunneled Intraperitoneal Catheter (Revision 2011) |
| 49423-CPT | Moderate | Replace Abscess/Cyst Catheter W Radiological Guidance (Sep Procedure) |
| 49424-CPT | Low | Contrast Injection For Assessment Of Abscess Or Cyst Via Previously Placed Drainage Catheter Or Tube (Separate Procedure) |
| 49425-CPT | Moderate | Peritoneal-Venous Shunt |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49423. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49423 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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