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 |
| CMS | $114.51 Physician Fee Schedule |
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 | $515.00 | 1497084982 - WAKE ENDOSCOPY CENTER, LLC | 611578919 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $414.00 | 1972147239 - CHILDREN'S SURGERY CENTER OF PHILADELPHIA LLC, CHILDREN'S DENTAL SURGERY OF PHILADELPHIA | 842886610 - (PA) CHILDRENS SURGERY CENTER OF PHILADELPHIA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $5532.00 | 1396700159 - DOCTORS SAME DAY SURGERY CENTER, LTD | 621614361 - (FL) DOCTORS SAME DAY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1050.00 | 1053835983 - GROUP SURGICAL PARTNERS INTEGRATED LLC, LEGENT OUTPATIENT SURGERY - FRISCO | 821249116 - (TX) GROUP SURGICAL PARTNERS INTEGRATED LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $487.00 | 1740448711 - TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | 262420083 - (PA) TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1233.00 | 1598996894 - SURGICAL ELITE OF AVONDALE, LLC | 270471437 - (AZ) SURGICAL ELITE OF AVONDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $426.00 | 1487043386 - DENTAL SURGICENTER OF LOUISVILLE INC | 464672803 - (KY) DENTAL SURGICENTER | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $3843.00 | 1437746674 - SUMMIT ORTHOPEDIC SURGERY CENTER, LLC, SOSC | 844141051 - (CO) SUMMIT ORTHOPEDIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $610.00 | 1558327213 - SURGICARE OF JACKSON LTD | 752162993 - (MS) SURGICARE OF JACKSON LTD | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $815.00 | 1093786501 - SURGERY CENTER OF EASTON LP, HEALTHSOUTH SURGERY CENTER OF EASTON, L.P. | 721349755 - (MD) SURGERY CENTER OF EASTON LP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $561.00 | 1609465269 - OKLAHOMA SPINE SURGERY CENTER | 861507485 - (OK) OKLAHOMA SPINE SURGERY CENTER | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49435 | $1104.00 | 1083686208 - WICHITA ORTHOPAEDIC ASC LLC, SURGERY CENTER OF KANSAS | 621659908 - (KS) WICHITA ORTHOPAEDIC ASC LLC | KS | 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 | $947.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | 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 | 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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