CPT 49425 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 • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49425 |
National average reimbursement for CPT 49425 by major payers:
$989.36
$982.35
$1,035.77
$1,240.16
| 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 49425 | ||||||
United | 49425 | $1233.00 | 1174802045 - LEONARDTOWN SURGERY CENTER LLC | 452019132 - (MD) LEONARDTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1150.00 | 1942637301 - MICHIANA SURGERY CENTER, LLC | 461007801 - (IN) MICHIANA SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $633.00 | 1447301593 - 481 ASC PROJECT LLC, EYE MD LASER & SURGERY CENTER LLC | 943272782 - (CA) 481 ASC PROJECT LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $546.00 | 1558859645 - EAST FREEDOM SURGICAL ASSOCIATES, LLC | 820930718 - (PA) EAST FREEDOM SURGICAL ASSOCIATES LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $273.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1258.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $250.00 | 1447279369 - EYE CENTER OF NORTH FLORIDA, P.A., THE LASER & SURGERY CENTER | 522107690 - (FL) EYE CENTER OF NORTH FLORIDA, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1400.00 | 1851407399 - SOUTHERN NEW MEXICO SURGERY CENTER, LLC | 201826172 - (NM) SOUTHERN NEW MEXICO SURGERY CENTER | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $2307.00 | 1326424144 - IU HEALTH EAST WASHINGTON AMBULATORY SURGERY CENTER, LLC, EAST WASHINGTON SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $489.00 | 1275569121 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE SURGICENTER-CASA GRANDE | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $3994.00 | 1194997965 - INDIANAPOLIS ENDOSCOPY CENTER LLP | 352010874 - (IN) INDIANAPOLIS ENDOSCOPY CENTER LLP | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $423.00 | 1447319603 - NORTHERN BALTIMORE SURGERY CENTER, LLC | 522234559 - (MD) NORTHERN BALTIMORE SURGERY CENTER 401(K) PLAN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $819.00 | 1518373695 - HOLLYWOOD SURGICAL CENTER, LLC | 462573171 - (FL) HOLLYWOOD SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $645.00 | 1437636636 - CCRM DFW, LLC, CCRM DALLAS FORT WORTH | 822959456 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1447.00 | 1639694797 - UCSD CENTER FOR SURGERY OF ENCINITAS, L.P. | 822326631 | 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 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 | 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 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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