CPT 49460 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $666.99 Physician Fee Schedule |
National average reimbursement for CPT 49460 by major payers:
$791.06
$997.26
$991.11
$1,166.94
| 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 49460 | ||||||
United | 49460 | $1253.98 | 1194834440 - LAURA DIAZ DEL CASTILLO | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 49460 | $750.00 | 1144745951 - METROPOLITAN SURGICAL CENTER, LLC | 821761609 - (MN) METROPOLITAN SURGICAL CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $611.00 | 1336605351 - KURESMART PAIN MANAGEMENT SURGERY CENTER, CLEARWAY SURGERY CENTER OF DUNDALK | 832407319 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $461.00 | 1306214705 - GSI ASC, LLC | 474883816 - (OK) GSI ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $625.00 | 1215981113 - ENGLEWOOD SURGERY CENTER, LLC | 421670784 - (CO) ENGLEWOOD SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $594.00 | 1922070911 - FAYETTEVILLE ASC LLC, NORTH HILLS GASTROENTEROLOGY ENDOSCOPY CENTER | 621691451 - (AR) FAYETTEVILLE ASC LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $749.00 | 1790744175 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, PUYALLUP ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $803.00 | 1912982349 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, MEDICAL ARTS SURGERY CENTER AT SOUTH MIAMI | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $794.00 | 1750331435 - EYE HEALTH ASSOCIATES INC | 161583927 - (NY) EYE HEALTH ASSOCIATES INCORPORAT | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $761.00 | 1629647268 - UNITED VASCULAR OF HUNTSVILLE, LLC | 832575902 - (AL) UNITED VASCULAR OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $1276.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $849.00 | 1962772871 - SURGERY CENTER OF NORTHEAST TEXAS LLC, SURGERY CENTER OF NORTHEAST TEXAS | 454184639 - (TX) SCNETX, LLCDBA SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $2807.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $560.00 | 1083030597 - TRIAD SURGERY CENTER, LLC, TRIAD EYE INSTITUTE | 465002052 - (OK) TRIAD EYE INSTITUTE, PLLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49460 | $1073.00 | 1740681733 - SURGCENTER OF GREATER PHOENIX, LLC | 465683789 - (AZ) SURGCENTER OF GREATER PHOENIX LLC | AZ | 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 49460 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49460 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 49460 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 |
| 49450-CPT | Moderate | Replacement Of Gastrostomy Or Cecostomy (Or Other Colonic) Tube Percutaneous Under Fluoroscopic Guidance Including Contrast Injection(S) Image Documentation And Report |
| 49460-CPT | Moderate | Mechanical Removal Of Obstructive Material From Gastrostomy, Duodenostomy, Jejunostomy, Gastro-Jejunostomy, Or Cecostomy (Or Other Colonic) Tube, Any Method, Under Fluoroscopic Guidance Including Contrast Injection(S), If Performed, 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 49460. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49460 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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