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See a sample rate comparisonCPT 49555 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.
Surgery For Pelvic Hernia, Surgery To Repair A Hernia In The Pelvic Crease -- The Joint Between The Upper Thigh And The Body.
| 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 49555 |
| Medicaid Fee Schedule | View Medicaid rates for 49555 |
National average reimbursement for CPT 49555 by major payers:
$836.50
$800.26
$834.41
$965.07
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CPT 49555
5 of 25 sample ratesHigher to lower in this preview
Spine Sports Surgery Center, LLC, Spine And Sports Surgery Center
$5,000.00Published rateSurgcenter Of Bel Air
Surgcenter Of Bel Air, LLC
$2,490.00Published rateChicago Prostate Cancer Surgery Center, LLC, Dupage Medical Group Surgery Center, Westmont
Chicago Prostate Cancer Surgery Center LLC
$1,869.00Published rateSt. Vincent-Arkansas Orthopaedic Surgery Center LLC
St Vincentarkansas Orthopaedic Surgery Center LLC
$987.00Published rateHotchkiss And Katzen Ambulatory Surgical Center, Metro Ambulatory Surgical Center
Hotchkiss And Katzen Ambulatory Surgical Center
$733.00Published rate
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See a sample payer proposalCPT 49555 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49555 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 49555 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 |
|---|---|---|
| 49550-CPT | Moderate | Surgery For Pelvic Hernia, Surgery To Repair A Hernia In The Pelvic Crease -- The Joint Between The Upper Thigh And The Body. |
| 49553-CPT | Moderate | Rpair Initial Fmoral Hernia Any Age; Ncarcerat Or Strangulated, Repair Initial Femoral Hernia Any Age; Incarcerated Or Strangulated |
| 49555-CPT | Moderate | Surgery For Pelvic Hernia, Surgery To Repair A Hernia In The Pelvic Crease -- The Joint Between The Upper Thigh And The Body. |
| 49557-CPT | High | Surgery For Pelvic Hernia, Surgery To Repair A Hernia In The Pelvic Crease -- The Joint Between The Upper Thigh And The Body. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49555. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49555 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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