CPT 49596 Fee Schedule
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.
| 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 |
| CMS | $998.86 Physician Fee Schedule |
National average reimbursement for CPT 49596 by major payers:
$1,309.62
$1,459.27
$1,382.34
$1,737.05
| 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 49596 | ||||||
United | 49596 | $3797.52 | 1306863386 - JENS-PETER WITT | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Neurological Surgery Physician (207T00000X) |
United | 49596 | $4513.43 | 1023794252 - NICOLE LINEHAN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Nurse Practitioner (363LP0200X) |
United | 49596 | $3544.35 | 1902874134 - JEFFREY CAMPBELL | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Urology Physician (2088P0231X) |
United | 49596 | $4034.00 | 1366868572 - PREMIER SURGERY CENTER, LLC | 463321793 - (NC) PREMIER SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49596 | $3825.00 | 1518149954 - NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER, LLC | 141983013 - (GA) NEUROLOGICAL INSTITUTE AMBULATORY SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49596 | $3489.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49596 | $6492.00 | 1346237328 - VICTORIA AMBULATORY SURGERY CENTER, LP, THE SURGERY CENTER | 352240144 - (TX) VICTORIA AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49596 | $2000.00 | 1669720439 - OCALA SURGICAL CENTER, OCALA SURGICAL CENTER, LLC | 842579958 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49596 | $3873.46 | 1710246905 - ANDREW TOFTOY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | ND | Orthopaedic Surgery Physician (207X00000X) |
United | 49596 | $3873.46 | 1083857205 - THOMAS PSHAK | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Transplant Surgery Physician (204F00000X) |
United | 49596 | $3027.01 | 1639445547 - ALLISON WOLFE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Internal Medicine Physician (207R00000X) |
United | 49596 | $3104.06 | 1881892826 - SARAH JOLLEY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 49596 | $3104.06 | 1619261641 - BETHANY DORAN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Cardiovascular Disease Physician (207RC0000X) |
United | 49596 | $4424.93 | 1801454996 - KARA STEFANIAK | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Physician Assistant (363A00000X) |
United | 49596 | $3632.40 | 1275853137 - FARRAH RAJABI | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Clinical Genetics (M.D.) Physician (207SG0201X) |
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 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 | 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 |
| 49596-CPT | High | 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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