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See a sample rate comparisonCPT 49425 Fee Schedule
Last Verified: October 2026
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.
Shunt Placement In Abdomen, Procedure To Insert Shunt (Passage That Allows Movement Of Fluid From One Part Of The Body To Another).
| 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 59 - Distinct Procedural Service AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49425 |
| Medicaid Fee Schedule | View Medicaid rates for 49425 |
National average reimbursement for CPT 49425 by major payers:
$989.36
$982.35
$1,035.77
$1,208.71
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CPT 49425
5 of 25 sample ratesHigher to lower in this preview
Indianapolis Endoscopy Center LLP
$3,994.00Published rateEndoscopy Center Of Dayton Ltd
$1,276.00Published rateComprehensive Pain Management Center, Inc.
$900.00Published rate481 Asc Project LLC, Eye Md Laser & Surgery Center LLC
481 Asc Project LLC
$633.00Published rateEye Center Of North Florida, P.A., The Laser & Surgery Center
Eye Center Of North Florida, P.A.
$250.00Published rate
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See a sample payer proposalCPT 49425 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49425 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 49425 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 49425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49425 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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