CPT 49435 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 • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision • 51 - Multiple procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 49435 |
National average reimbursement for CPT 49435 by major payers:
$157.10
$161.16
$166.09
$202.76
| 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 49435 | ||||||
United | 49435 | $821.00 | 1114291440 - PREMIER ASC LLC, PREMIER ORTHOPAEDIC SURGERY CENTER | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1388.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $450.00 | 1568556488 - SUNCOAST EYE CENTER PA, SUNCOAST SURGERY INSTITUTE | 592337219 - (FL) SUNCOAST EYE CENTER PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1276.00 | 1124125604 - MURDOCK AMBULATORY SURGERY CENTER LLC | 201543128 - (FL) MURDOCK AMBULATORY SURGERY CENTE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $671.00 | 1205809795 - OAKHURST ENDOSCOPY ASC LLC, OCEAN SURGICAL PAVILION, INC. | 223182653 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $520.00 | 1609930676 - BAYWOOD MEDICAL ASSOCIATES, PLLC, DESERT PAIN INSTITUTE - ASC | 861006533 - (AZ) BAYWOOD MEDICAL ASSOCIATES, PLLC DBA DESERT PAIN INSTITUTE | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $803.00 | 1033105960 - SURGERY CENTER OF OAK RIDGE, LLC, ADVANCED FAMILY SURGERY CENTER | 621801416 - (TN) ADVANCED FAMILY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $2426.00 | 1528121316 - SAINT LUKES SOUTH SURGERY CENTER LLC | 201721929 - (KS) SAINT LUKES SOUTH SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $2566.00 | 1932146990 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $670.00 | 1619370434 - SANDPOINT SURGERY CENTER LLC | 465723093 - (ID) SANDPOINT SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $2281.00 | 1093444010 - SUMMIT MEDICAL GROUP PA | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $883.00 | 1457552846 - CHESTERFIELD SPINE CENTER, LLC, ST. LOUIS SPINE AND ORTHOPEDIC SURGERY CENTER | 205044859 - (MO) CHESTERFIELD SPINE CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1202.00 | 1861059818 - FISHERS SPECIALTY SURGERY CENTER, LLC, ORTHOALLIANCE OF INDIANA | 833241405 - (IN) FISHERS SPECIALTY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1245.00 | 1073081501 - MILFORD-FRANKLIN EYE CENTER, LLC | 43287594 - (MA) MILFORD-FRANKLIN EYE CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $767.00 | 1720085384 - ELMHURST OUTPATIENT SURGERY CENTER LLC | 364150045 - (IL) ELMHURST OUTPATIENT SURGERY CENTER, LLC | IL | 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 49435 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49435 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 49435 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 |
|---|---|---|
| 49425-CPT | Moderate | Peritoneal-Venous Shunt |
| 49426-CPT | Moderate | Revision Peritoneal-Venous Shunt |
| 49427-CPT | Low | Inj Proc Eval Placd Perit-Ven Shunt |
| 49435-CPT | Low | Insertion Of Subcutaneous Extension To Intraperitoneal Cannula Or Catheter With Remote Chest Exit Sit (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49435. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49435 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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