CPT 49495 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 • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Moderate |
| CMS | $403.68 Physician Fee Schedule |
National average reimbursement for CPT 49495 by major payers:
$555.96
$538.32
$589.05
$668.67
| 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 49495 | ||||||
United | 49495 | $1863.00 | 1679544290 - KEYSTONE SURGERY CENTER, LTD | 43712391 - (PA) KEYSTONE SURGERY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $3347.00 | 1851710735 - SURGCENTER TUCSON, LLC | 462350774 - (AZ) SURGCENTER TUCSON, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $1125.00 | 1902020522 - ROME SURGICAL CENTER, P.C. | 208847972 - (GA) ROME SURGICAL CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $3347.00 | 1154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC | 833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $2795.00 | 1942267893 - GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA | 223345724 - (NJ) GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $1416.00 | 1164012142 - COMPREHENSIVE DIGESTIVE SURGICENTER, LLC, COMPREHENSIVE DIGESTIVE SURGICAL CENTER | 854015524 - (NV) COMPREHENSIVE DIGESTIVE SURGICENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $3250.00 | 1194489757 - WALNUT CREEK SURGICAL SUITES, LLC | 852525715 - (OH) WALNUT CREEK SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $1925.00 | 1366761397 - MEDINA-SUMMIT AMBULATORY SURGERY CENTER, THE MEDINA SURGERY CENTER | 261421110 - (OH) SUMMA HEALTH, PENSION ADMINISTATION COMMITTEE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $2880.00 | 1639498454 - NEW VISTA HEALTH, LLC, PINEY POINT SURGERY CENTER | 272416864 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $650.00 | 1538154604 - PAIN MANAGEMENT & SURGERY CENTER OF SOUTHERN INDIANA | 351972676 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $4498.00 | 1225275688 - MAIN STREET SPECIALTY SURGERY CENTER, LLC | 954813223 - (CA) MAIN STREET SPECIALTY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $3623.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $700.00 | 1386632610 - LHZ LIMITED PTR, SAINT CLARE SURGERY CENTER | 341816442 - (OH) LHZ LIMITED PTR | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $1686.00 | 1134182660 - CORAL SPRINGS SURGI-CENTER LTD | 650538147 - (FL) CORAL SPRINGS SURGICENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49495 | $6530.00 | 1528438884 - MCLEAN AMBULATORY SURGERY, LLC | 474966649 - (VA) MCLEAN AMBULATORY SURGERY LLC | VA | 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 49495 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49495 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 49495 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 49495. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49495 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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