CPT 49600 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $722.30 Physician Fee Schedule |
National average reimbursement for CPT 49600 by major payers:
$921.63
$971.17
$1,013.14
$1,195.39
| 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 49600 | ||||||
United | 49600 | $887.00 | 1972556942 - CHERRY HILL WOMEN'S CENTER, INC. | 232068660 - (NJ) CHERRY HILL WOMENS CENTER INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $3347.00 | 1386086411 - MARION SURGERY CENTER, LLC | 462447139 - (FL) MARION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $2538.00 | 1407836315 - SPINE CARE DELAWARE, LLC | 510393046 - (DE) SPINE CARE DELAWARE LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $2586.00 | 1881089076 - FREEMAN SURGICAL CENTER OF PITTSBURG, LLC | 473537670 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $1800.00 | 1760196984 - JACKSON HEART AND VASCULAR CENTER LLC | 870947298 - (MS) JACKSON HEART AND VASCULAR CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $2277.00 | 1578610564 - HOLDINGS OF SPINECARE, LLC, SPINECARE LLP | 200950730 - (TX) HOLDINGS OF SPINECARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $588.00 | 1285633818 - FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | 522208568 - (MD) FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $3623.00 | 1447362769 - BETHLEHEM ENDOSCOPY CENTER LLC | 233032591 - (PA) BETHLEHEM ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $617.00 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $642.00 | 1750331500 - ARMENIA AMBULATORY SURGERY CENTER LLC, MEDICAL VILLAGE SURGICAL CENTER | 270946506 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $809.00 | 1285065490 - MASON ESC, LLC, MASON EYE SURGERY CENTER | 462015301 - (NY) MASON ESC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $856.00 | 1578535233 - SUN CITY OPHTHALMOLOGY ASC LLC, EYE INSTITUTE AT BOSWELL | 621737549 - (AZ) SUN CITY OPHTHALMOLOGY ASSOC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $6941.00 | 1346403854 - THE EMORY CLINIC INC, EMORY ORTHOPAEDIC SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $758.00 | 1295131001 - OPTUMCARE COLORADO ASC, LLC, COLORADO SPRINGS HEALTH PARTNERS ASC, LLC | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49600 | $2860.00 | 1912090432 - MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC | 812557673 - (DC) MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE LLC | DC | 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 49600 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49600 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 49600 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 |
|---|---|---|
| 49600-CPT | Moderate | Rep Omphalocele Small W Prim Close |
| 49605-CPT | High | Rep Omphalocele Large/Gastroschisis |
| 49606-CPT | High | Repair Of Large Omphalocele Or Gastroschisis; With Removal Of Prosthesis, Final Reduction And Closure, In Operating Room |
| 49610-CPT | Moderate | Rep Omphalocele Gross Type 1st Stg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49600. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49600 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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