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See a sample rate comparisonCPT 49520 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.
Rep Hernia Inguin Recurrent > 5 Yrs
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49520 |
| Medicaid Fee Schedule | View Medicaid rates for 49520 |
National average reimbursement for CPT 49520 by major payers:
$840.52
$842.15
$902.99
$1,013.51
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CPT 49520
5 of 25 sample ratesHigher to lower in this preview
Virginia Mason Medical Center, Virginia Mason Issaquah Asc
Virginia Mason Medical Center
$6,399.00Published rateMontpelier Surgery Center
$2,609.00Published rateBay Microsurgical Unit
$1,189.00Published rateSpecialty Surgical Center Of Irvine Lp
Specialty Surgical Center Of Irvine, Lp
$725.00Published rateDilnoza Nasritdinova
Deaconess Hospital Inc
$501.20Published rate
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See a sample payer proposalCPT 49520 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49520 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 49520 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 49520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49520 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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