CPT 49591 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49591 |
National average reimbursement for CPT 49591 by major payers:
$443.35
$488.01
$474.51
$589.49
| 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 49591 | ||||||
United | 49591 | $1269.97 | 1104561489 - CALI ORMSBY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Medical Physician Assistant (363AM0700X) |
United | 49591 | $1509.40 | 1033245139 - MICHAEL WITTKAMP | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 49591 | $1479.80 | 1457586851 - JOSEPH DAVIS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | IN | Pediatric Radiology Physician (2085P0229X) |
United | 49591 | $1038.06 | 1831762095 - LAURA MATTOX | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Adult Health Nurse Practitioner (363LA2200X) |
United | 49591 | $588.97 | 1427187780 - JENNIE MILLER | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Physician Assistant (363A00000X) |
United | 49591 | $1038.06 | 1649667650 - CHARLES BENGSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Anesthesiology Physician (207L00000X) |
United | 49591 | $1012.29 | 1811382054 - WHITNEY GIAMBERARDINO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Obstetrics & Gynecology Physician (207V00000X) |
United | 49591 | $1643.00 | 1558859645 - EAST FREEDOM SURGICAL ASSOCIATES, LLC | 820930718 - (PA) EAST FREEDOM SURGICAL ASSOCIATES LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49591 | $1479.80 | 1902914229 - SARAH MILLA | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Diagnostic Radiology Physician (2085R0202X) |
United | 49591 | $1038.06 | 1861867632 - JILL BROGDON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Family Nurse Practitioner (363LF0000X) |
United | 49591 | $800.00 | 1467582437 - NORTH FLORIDA SURGERY CENTER INC, NORTH FLORIDA SURGERY CENTER | 593377918 - (FL) NORTH FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49591 | $1038.06 | 1629173976 - KIA MCLEAN WASHINGTON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | PA | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 49591 | $2774.00 | 1619245230 - AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | 800768614 - (NJ) AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49591 | $1214.76 | 1033224944 - ANGELA CZAJA | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 49591 | $3968.00 | 1881692036 - SAINT BARNABAS OUTPATIENT CENTERS, AMBULATORY SURGERY CENTER | 222458479 - (NJ) SAINT BARNABAS OUTPATIENT CENTERS | NJ | 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 49591 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49591 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 49591 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 |
|---|---|---|
| 49591-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Initial, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); Less Than 3 Cm, Reducible |
| 49592-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Initial, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); Less Than 3 Cm, Incarcerated Or Strangulated |
| 49593-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Initial, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); 3 Cm To 10 Cm, Reducible |
| 49594-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Initial, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); 3 Cm To 10 Cm, 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 49591. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49591 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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