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See a sample rate comparisonCPT 49496 Fee Schedule
Last Verified: October 2026
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.
Rpr Ing Hernia Baby Blocked, 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
| 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 RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49496 |
| Medicaid Fee Schedule | View Medicaid rates for 49496 |
National average reimbursement for CPT 49496 by major payers:
$800.56
$808.36
$868.94
$980.36
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CPT 49496
5 of 25 sample ratesHigher to lower in this preview
Rock Hill Surgery Center, LLC, Carolina Surgical Center
Rock Hill Surgery Center LLC
$9,100.00Published rateOrthopedic Associates Surgery Center LLC
$3,201.00Published rateCornerstone Surgicare LLC
$1,800.00Published rateFlorida Endoscopy And Surgery Center, LLC, Hernando Endoscopy & Surgery Center
Florida Endoscopy And Surgery Center, LLC
$1,260.00Published rateTranssouth Health Care PLLC, Transsouth Health Care PC
Transsouth Health Care, P.C.
$720.00Published rate
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See a sample payer proposalCPT 49496 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49496 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 49496 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 | Rpr Hern Preemie Reduc, 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 | Rpr Ing Hern Premie Blocked, 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 | Rpr Ing Hernia Baby Reduc, 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 | Rpr Ing Hernia Baby Blocked, 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 49496. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49496 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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