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See a sample rate comparisonHealthcare 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 | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 49424 |
| Medicaid Fee Schedule | View Medicaid rates for 49424 |
National average reimbursement for CPT 49424 by major payers:

$184.80

$209.76

$242.28

$76.04
Choose a payer to see a sample of rates for CPT 49424.
Monmouth Medical Center Faculty Practice Plan Inc
St Joseph Hospital
Advantagecare Physicians, P.C.
Dermatology And Skin Surgery Center
Charleston Radiologists, P.A.
Choose your state and specialty to build a report from payer-published rates.
Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 49424 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49424 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 49424 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 | 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). |
| 49425-CPT | Moderate | Shunt Placement In Abdomen, Procedure To Insert Shunt (Passage That Allows Movement Of Fluid From One Part Of The Body To Another). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49424. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49424 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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