CPT 49442 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 51 - Multiple procedures • 59 - Distinct Procedural Service • 52 - Reduced Services • 58 - Staged or related procedure during postoperative period • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $734.59 Physician Fee Schedule |
National average reimbursement for CPT 49442 by major payers:
$1,052.19
$1,247.37
$1,191.50
$1,372.26
| 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 49442 | ||||||
United | 49442 | $1258.00 | 1790241073 - HSS PALM BEACH AMBULATORY SURGERY CENTER, LLC | 301015589 - (FL) HSS PALM BEACH AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $956.00 | 1275821746 - OREGON EAR NOSE AND THROAT SURGERY | 452437880 - (OR) OREGON EAR NOSE AND THROAT SURGERY | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $545.00 | 1770911463 - SALUBRIOUS ASC, LLC | 463866454 - (GA) SALUBRIOUS ASC LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $1276.00 | 1326435926 - SELECT PHYSICIANS SURGERY CENTERS | 383935220 - (FL) SELECT PHYSICIANS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $775.00 | 1306242466 - AMSC, LLC, DOWNTOWN BRONX ASC | 201927382 - (NY) AMSC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $1175.00 | 1861931263 - METHODIST CRAIG RANCH SURGERY CENTER LLC | 352583971 - (TX) METHODIST CRAIG RANCH SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $800.00 | 1043564784 - COMPREHENSIVE SURGICAL CENTER OF GREEN, LLC | 461313857 - (OH) COMPREHENSIVE SURGICAL CENTER OF GREEN LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $2817.00 | 1497312540 - MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC | 384114079 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $800.00 | 1356672919 - CPMSC ROSWELL, LLC | 271697405 - (GA) CPMSC ROSWELL LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $492.00 | 1285944504 - NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC | 272840356 - (MD) NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $560.00 | 1902960206 - SINUS SURGERY CENTER IDAHO PA | 205282962 - (ID) SINUS SURGERY CENTER IDAHO PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $1500.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 843362063 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $1749.00 | 1952364499 - DENTON REGIONAL AMBULATORY SURGERY CENTER, L.P., MEDICAL CITY SURGERY CENTER/DENTON | 200270605 - (TX) DENTON REGIONAL AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $536.00 | 1447366224 - WEST MICHIGAN SURGERY CENTER, LLC | 371509502 - (MI) MICHIGAN PRIMARY CARE PARTNERS PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49442 | $580.00 | 1750927190 - HERMITAGE ENDOSCOPY CENTER INC | 841815468 - (PA) HERMITAGE ENDOSCOPY CENTER INC | PA | 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 49442 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49442 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 49442 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 |
|---|---|---|
| 49441-CPT | High | Insertion Of Duodenostomy Or Jejunostomy Tube, Percutaneous, Under Fluoroscopic Guidance Including Contrast Injection(S), Image Documentation And Report |
| 49442-CPT | High | Insertion Of Cecostomy Or Other Colonic Tube, Percutaneous, Under Fluoroscopic Guidance Including Contrast Injection(S), Image Documentation And Report |
| 49446-CPT | Moderate | Conversion Of Gastrostomy Tube To Gastro- Jejunostomy Tube Percutaneous Under Fluorscopic Guidance Including Contract Injection(S) Image Documentation & Report |
| 49450-CPT | Moderate | Replacement Of Gastrostomy Or Cecostomy (Or Other Colonic) Tube Percutaneous Under Fluoroscopic Guidance Including Contrast Injection(S) Image Documentation And Report |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49442. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49442 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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