CPT 49426 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49426 |
National average reimbursement for CPT 49426 by major payers:
$825.34
$871.90
$897.05
$1,077.51
| 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 49426 | ||||||
United | 49426 | $1644.00 | 1619643608 - CARDIOVASCULAR ASC LLC | 462883732 - (FL) CARDIOVASCULAR ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $3695.00 | 1245233220 - NORTHRIDGE SURGERY CENTER, LP, NORTHRIDGE SURGERY CENTER | 690003768 - (TN) NORTHRIDGE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $1400.00 | 1225488216 - MADISON AVENUE SURGERY CENTER LLC | 475541001 - (ID) MADISON AVENUE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $3495.00 | 1306833009 - SOUTH BROWARD ENDOSCOPY L L C | 113685842 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $5923.00 | 1700546629 - STONE OAK SURGICENTER, LLC | 873925488 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $4781.00 | 1427049352 - CENTER FOR AMBULATORY SURGERY, LLC, THE CENTER FOR AMBULATORY SURGERY | 223638149 - (NJ) THE CENTER FOR AMBULATORY SURGERY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $3659.00 | 1487693123 - CLARKSVILLE SURGERY CENTER LLC | 621752518 - (TN) CLARKSVILLE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $1819.00 | 1508911728 - MINIMALLY INVASIVE SURGICAL AND NEUROSCIENCE LLC, DELAWARE OUTPATIENT CENTER FOR SURGERY | 161694674 - (DE) DELAWARE OUTPATIENT CENTER FOR SURGERY | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $4379.00 | 1255936761 - CROWN POINT SURGICAL SUITES, LLC | 851476511 - (IN) CROWN POINT SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $1800.00 | 1164930731 - REMBRANDT OUTPATIENT SURGERY CENTER PLLC, REMBRANDT OUTPATIENT SURGERY CENTER | 822368976 - (AZ) REMBRANDT OUTPATIENT SURGERY CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $640.00 | 1891049441 - ISLAND DIGESTIVE HEALTH CENTER, LLC | 452411095 - (NY) ISLAND DIGESTIVE HEALTH CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $1200.00 | 1588839609 - RIVERWALK AMBULATORY SURGERY CENTER LLC | 260594903 - (FL) RIVERWALK AMBULATORY SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $1563.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $818.00 | 1437129723 - AFFINITY OUTPATIENT SERVICES | 582189333 - (GA) AFFINITY HEALTH GROUP, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49426 | $7147.00 | 1649482449 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | 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 49426 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49426 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 49426 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) |
| 49426-CPT | Moderate | Revision 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 49426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49426 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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