CPT 49452 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 • AG - Primary physician |
| Complexity Level | Moderate |
| CMS | $713.56 Physician Fee Schedule |
National average reimbursement for CPT 49452 by major payers:
$935.32
$1,187.08
$1,223.81
$1,311.32
| 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 49452 | ||||||
United | 49452 | $1548.04 | 1962451245 - SHOAIB ALAM | 350593390 - DEACONESS HOSPITAL INC | VA | Pulmonary Disease Physician (207RP1001X) |
United | 49452 | $1548.04 | 1245248293 - JAMESON WAY | 350593390 - DEACONESS HOSPITAL INC | IN | Neurology Physician (2084N0400X) |
United | 49452 | $711.26 | 1669191730 - ALLISON CARDER | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 49452 | $1511.93 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49452 | $1173.86 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49452 | $1511.93 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 49452 | $1548.04 | 1245298066 - SATYAM TATINENI | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 49452 | $1548.04 | 1255473625 - HILARY NWOSU | 350593390 - DEACONESS HOSPITAL INC | CA | Emergency Medicine Physician (207P00000X) |
United | 49452 | $1548.04 | 1104874379 - JAMES NEAHRING | 350593390 - DEACONESS HOSPITAL INC | IN | Cardiovascular Disease Physician (207RC0000X) |
United | 49452 | $1548.04 | 1548640808 - DANIEL CATER | 350593390 - DEACONESS HOSPITAL INC | IN | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 49452 | $524.60 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 49452 | $508.32 | 1386694362 - JOSEPH SCHUSTER | 222991679 | NJ | Internal Medicine Physician (207R00000X) |
United | 49452 | $609.97 | 1386694362 - JOSEPH SCHUSTER | 222991679 | NJ | Internal Medicine Physician (207R00000X) |
United | 49452 | $1731.12 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 49452 | $562.90 | 1104810936 - JORGE OSORIO | 223443643 - (NJ) RENAISSANCE MEDICAL GROUP PA | NJ | Internal Medicine Physician (207R00000X) |
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 49452 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49452 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 49452 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 |
| 49452-CPT | Moderate | Replacement Of Gastro-Jejunostomy 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 49452. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49452 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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