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See a sample rate comparisonCPT 49596 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Rpr Aa Hrn 1st 10 Ncr Strn, 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 Greater Than 10 Cm Incarcerated Or Strangulated
| 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 AS - PA/NP/CNS assistant at surgery 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49596 |
| Medicaid Fee Schedule | View Medicaid rates for 49596 |
National average reimbursement for CPT 49596 by major payers:
$1,309.62
$1,459.27
$1,382.34
$1,674.63
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CPT 49596
5 of 25 sample ratesHigher to lower in this preview
Onyx & Pearl Surgical Suites LLC
Onyx & Pearl Surgical Suites, LLC
$6,492.00Published rateRyan Keenan
University Physicians Incorporated
$3,797.52Published rateKatie Egan
University Physicians Incorporated
$3,104.06Published rateLogan Mckenna
Ihc Health Services Inc
$2,262.95Published rateAllan Nguyen
Vista Surgical Group
$1,586.00Published rate
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See a sample payer proposalCPT 49596 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49596 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 49596 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 | Rpr Aa Hrn 1st 3 Cm Rdc, 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 | Rpr Aa Hrn 1st 3 Ncr Strn, 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 | Rpr Aa Hrn 1st 3 10 Rdc, 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 |
| 49596-CPT | High | Rpr Aa Hrn 1st 10 Ncr Strn, 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 Greater Than 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 49596. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49596 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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