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 |
| CMS | $765.97 Physician Fee Schedule |
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 | $546.00 | 1558859645 - EAST FREEDOM SURGICAL ASSOCIATES, LLC | 820930718 - (PA) EAST FREEDOM SURGICAL ASSOCIATES LLC | PA | 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 | $669.00 | 1093121196 - GULF COAST OUTPATIENT SURGERY CENTER, LLC | 640935301 - (MS) GULF COAST OUTPATIENT SURGERY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1276.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $455.00 | 1295739217 - WATERSIDE AMBULATORY SURGICAL CENTER LLC | 650270415 - (FL) WATERSIDE AMBULATORY SURGICAL CE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $396.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $724.00 | 1497727119 - DIGESTIVE ENDOSCOPY CENTER LLC, DIGESTIVE ENDOSCOPY CENTER | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1528.00 | 1205195716 - ADVANCED ENDOSCOPY AND PAIN CENTER LLC | 454651695 - (CA) ADVANCED ENDOSCOPY AND PAIN CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1886.00 | 1891745956 - NORTH SUBURBAN SPINE CENTER LP, NORTH METRO SURGERY CENTER | 571231282 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $654.00 | 1104880723 - WNC EYE SURGERY CENTERS INC | 200067898 - (NC) WNC EYE SURGERY CENTERS INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $700.00 | 1285108845 - MARIETTA ADVANCED SURGERY CENTER | 832382468 - (GA) MARIETTA ADVANCED SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $1367.00 | 1093960700 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE HIGHLANDS SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $750.00 | 1538722699 - R & R SURGICAL CENTERS | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $725.00 | 1023160553 - ALBANY SURGERY CENTER, LLP | 582437516 - (GA) ALBANY SURGERY CENTER LLP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49425 | $2307.00 | 1568410926 - MERIDIAN MEDICAL GROUP PC, MERIDIAN ENDOSCOPY CENTER | 208398421 | IN | 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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