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See a sample rate comparisonCPT 49521 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.
Rpair Recurrent Inguinal Hernia Any Age; Ncarcerat Or Strangulat, Repair Recurrent Inguinal Hernia Any Age; Incarcerated Or Strangulate
| 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 49521 |
| Medicaid Fee Schedule | View Medicaid rates for 49521 |
National average reimbursement for CPT 49521 by major payers:
$958.68
$972.19
$1,021.84
$1,158.47
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CPT 49521
5 of 25 sample ratesHigher to lower in this preview
The Western Pennsylvania Hospital, Forbes Regional Campus
Highmark Health
$20,210.81Published rateGlen Echo Surgery Center, LLC
Glen Echo Surgery Center LLC
$3,500.00Published rateWestern Connecticut Orthopedic Surgical Center LLC, The Hand Center Of Western Connecticut LLC
The Hand Center Of Western Connecticut, L.L.C.
$2,750.00Published rateNorth Pacific Dermatology Ps
$1,849.00Published rateDcr Surgery Center, LLC
Dcr Surgery Center LLC
$830.00Published rate
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See a sample payer proposalCPT 49521 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49521 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 49521 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 49521. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49521 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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