CPT 49507 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 |
| Medicare Fee Schedule | View Medicare rates for 49507 |
National average reimbursement for CPT 49507 by major payers:
$795.35
$797.38
$861.05
$954.03
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 49507 | $464.89 | 1326822503 - ALEXIS SOSH | 350593390 - DEACONESS HOSPITAL INC | IN | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 49507 | $2050.00 | 1346773421 - WOMEN'S CARE FLORIDA LLC, WOMEN'S CARE FLORIDA SURGICAL CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $1152.00 | 1093764045 - GASTROENTEROLOGY OF INDIANAPOLIS PC, DIGESTIVE HEALTH CENTER | 351641181 - (IN) GASTROENTEROLOGY OF INDIANAPOLIS, P . C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $6530.00 | 1689832438 - INOVA WOODBURN SURGERY CENTER LLC | 540620889 - INOVA HEALTH CARE SERVICES | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $820.00 | 1750920591 - HAYDEN SURGICAL CENTER LLC | 844085494 - (AZ) HAYDEN SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $1998.00 | 1205871050 - KLAMATH SURGERY CENTER LLC, KLAMATH SURGEONS LLC | 911836091 - (OR) KLAMATH SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $867.00 | 1447442876 - MAPLE SPRINGS PODIATRIC SURGICAL CENTER, INC | 521883407 - (MD) MAPLE SPRINGS PODIATRIC SURGICAL CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $1555.00 | 1295287522 - MIDTOWN SURGERY CENTER | 473103507 - (GA) MIDTOWN SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $6904.00 | 1083644124 - MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP, MEMORIAL HERMANN SURGERY CENTER SOUTHWEST | 202866884 - (TX) MEMORIAL HERMANN SURGERY CENTER SOUTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $2103.00 | 1558363549 - SUSQUEHANNA VALLEY SURGERY CENTER | 251847818 - (PA) SUSQUEHANNA VALLEY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $1852.00 | 1467833160 - AUSTELL SURGERY CENTER, LLC | 473077378 - (GA) AUSTELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $5213.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $1416.00 | 1023071180 - SAHARA OUTPATIENT SURGERY CENTER LTD | 752509486 - (NV) SAHARA OUTPATIENT SURGERY CENTER LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $3570.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49507 | $464.89 | 1851575476 - MARTIN KELLY | 350593390 - DEACONESS HOSPITAL INC | AR | Certified Registered Nurse Anesthetist (367500000X) |
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 49507 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49507 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 49507 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 |
|---|---|---|
| 49505-CPT | Moderate | Groin Hernia Repair Surgery, Surgery To Repair Inguinal (Groin) Hernia That Can Be Gently Pushed Back Through The Muscle Where The Leg And The Belly Meet. |
| 49507-CPT | Moderate | Groin Hernia Repair Surgery, Surgery To Repair Inguinal (Groin) Hernia That Can Be Gently Pushed Back Through The Muscle Where The Leg And The Belly Meet. |
| 49520-CPT | Moderate | Rep Hernia Inguin Recurrent > 5 Yrs |
| 49521-CPT | Moderate | Rpair Recurrent Inguinal Hernia Any Age; Ncarcerat Or Strangulat, Repair Recurrent Inguinal Hernia Any Age; Incarcerated Or Strangulate |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49507. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49507 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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