CPT 49491 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 • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49491 |
National average reimbursement for CPT 49491 by major payers:
$1,033.87
$1,045.53
$1,140.64
$1,294.44
| 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 49491 | ||||||
United | 49491 | $2445.00 | 1508318411 - INTERVENTIONAL SPINE CENTER, LLC | 263161503 - (CA) INTERVENTIONAL SPINE CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $2910.00 | 1477242154 - PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC, PLYMOUTH ORTHOPEDIC SURGERY CENTER | 883632673 - (MN) PLYMOUTH ORTHOPEDIC SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $3050.00 | 1811076623 - SPARTANBURG SURGERY CENTER, LLC | 570953005 - (SC) SPARTANBURG SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $2900.00 | 1952852345 - HUEBNER AMBULATORY SURGERY CENTER, LLC | 813360799 - (TX) HUEBNER AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $3623.00 | 1851396014 - ARC WORCESTER CENTER, L.P. | 621772057 - (MA) ARC WORCESTER CENTER LP | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $3570.00 | 1295163715 - BLUFFTON OKATIE SURGERY CENTER, L.L.C. | 364730753 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $1686.00 | 1427012202 - OUTPATIENT SURGICAL SERVICES LTD | 752433596 - (FL) OUTPATIENT SURGICAL SERVICES LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $5329.00 | 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 | 49491 | $3570.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $1729.00 | 1982268322 - SURGERY CENTER ON 27 LLC | 812733475 - (FL) SURGERY CENTER ON 27 LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $1571.00 | 1447254172 - SURGICENTER OF BALTIMORE LLC, SURGICENTER OF BALTIMORE | 521658841 - (MD) SURGICENTER OF BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $759.00 | 1497727119 - DIGESTIVE ENDOSCOPY CENTER LLC, DIGESTIVE ENDOSCOPY CENTER | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $6353.00 | 1659793891 - INOVA AMBULATORY SURGERY CENTER AT LORTON, LLC | 461955980 - (VA) INOVA AMBULATORY SURGERY CENTER AT LORTON LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $1927.00 | 1770837866 - SPINE AND PAIN PHYSICIANS SURGERY CENTER, LLC | 454831116 - (TN) SPINE AND PAIN PHYSICIANS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49491 | $565.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | 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 49491 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49491 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 49491 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 |
|---|---|---|
| 49491-CPT | High | Repair, Initial Inguinal Hernia, Preterm Infant (Younger Than 37 Weeks Gestation At Birth), Performed From Birth Up To 50 Weeks Postconception Age, With Or Without Hydrocelectomy; Reducible |
| 49492-CPT | High | Repair, Initial Inguinal Hernia, Preterm Infant (Younger Than 37 Weeks Gestation At Birth), Performed From Birth Up To 50 Weeks Postconception Age, With Or Without Hydrocelectomy; Incarcerated Or Strangulated |
| 49495-CPT | Moderate | Repair, Initial Inguinal Hernia, Full Term Infant Younger Than Age 6 Months, Or Preterm Infant Older Than 50 Weeks Postconception Age And Younger Than Age 6 Months At The Time Of Surgery, With Or Without Hydrocelectomy; Reducible |
| 49496-CPT | Moderate | Repair, Initial Inguinal Hernia, Full Term Infant Younger Than Age 6 Months, Or Preterm Infant Older Than 50 Weeks Postconception Age And Younger Than Age 6 Months At The Time Of Surgery, With Or Without Hydrocelectomy; Incarcerated Or Strangulated |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49491 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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