CPT 49501 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| CMS | $598.09 Physician Fee Schedule |
National average reimbursement for CPT 49501 by major payers:
$832.15
$801.25
$862.88
$990.20
| 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 49501 | ||||||
United | 49501 | $912.00 | 1265465025 - GEORGIA SURGICAL CENTERS INC | 43650858 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $4031.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $1985.00 | 1962959296 - RUSH-COPLEY SURGICENTER, LLC, CASTLE SURGICENTER | 384012268 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $3880.00 | 1003847500 - WESTSIDE OUTPATIENT CENTER, LLC, PALMS WELLINGTON SURGICAL CENTER | 651078372 - (FL) WESTSIDE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $2600.00 | 1629429410 - LAKEVIEW SURGERY CENTER LLC | 811806084 - (MD) LAKEVIEW SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $1065.00 | 1588879266 - BAYSIDE ENDOSCOPY CENTER LLC, EAST GREENWICH ENDOSCOPY CENTER | 200207545 - (RI) BAYSIDE ENDOSCOPY CENTER LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $11304.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $3926.00 | 1205030731 - PIERCE STREET SAME DAY SURGERY, LC, PIERCE STREET SAME DAY SURGERY, LC | 205895205 - (IA) PIERCE STREET SAME DAY SURGERY | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $2632.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $4339.00 | 1063092047 - TAMPA BAY JOINT AND SPINE, LLC, TAMPA BAY JOINT AND SPINE SURGERY CENTER | 851259146 - (FL) TAMPA BAY JOINT AND SPINE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $1135.00 | 1629016076 - UNIVERSITY CENTER FOR AMBULATORY SURGERY, LLC, UCAS, LLC | 522149129 - UNIVERSITY CENTER FOR AMBULATORY SURGERY, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $1525.00 | 1386300119 - LEE HEALTHCARE INVESTMENTS, LLC, LEE HEALTH UROLOGY SURGERY CENTER | 843798404 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $971.00 | 1265966444 - CHILDREN'S SURGERY CENTER OF LEHIGH VALLEY, LLC | 611830897 - (PA) CHILDRENS SURGERY CENTER OF LEHIGH VALLEY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $4376.77 | 1649748708 - ANKENY MEDICAL PARK SURGERY CENTER LC | 831281114 - (IA) ANKENY MEDICAL PARK SURGERY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49501 | $5310.00 | 1811318785 - CONNECTICUT ORTHOPAEDIC SPECIALISTS OUTPATIENT SURGICAL CENTER LLC | 462819773 | CT | 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 49501 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49501 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 49501 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 |
| 49501-CPT | Moderate | Repair Initial Inguinal Hernia, Age 6 Months To Younger Than 5 Years, 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 49501. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49501 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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