CPT 49606 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| CMS | $1,110.13 Physician Fee Schedule |
National average reimbursement for CPT 49606 by major payers:
$1,412.60
$1,522.25
$1,592.20
$1,855.23
| 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 49606 | ||||||
United | 49606 | $1028.00 | 1528077658 - PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC, PRINCE WILLIAM SURGERY CENTER | 770594498 - (VA) PRINCE WILLIAM AMBULATORY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $682.00 | 1558003764 - NORTH CHAPEL HILL SURGERY CENTER LLC | 463242402 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $529.00 | 1750505756 - SJ MEDICAL CENTER, LLC | 204835578 - (TX) SJ MEDICAL CENTER, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $775.00 | 1932719754 - RESTORATIVE SURGERY CENTER LLC, IPS SURGERY CENTER, LLC | 862855145 - (MO) RESTORATIVE SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $1274.00 | 1740371665 - SUMMIT SURGICAL ASSOCIATES LLC, SUMMIT SURGICAL CENTER | 954810282 - (CA) SUMMIT SURGICAL | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $541.00 | 1225107014 - COMMONWEALTH EYE CLINIC INC | 611140257 - (KY) COMMONWEALTH EYE CLINIC INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $122.00 | 1699711556 - ESCNC LLC, EYE SURGERY CENTER OF NORTHERN CALIFORNIA | 462800751 - (CA) ESCNC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $6362.00 | 1578561890 - THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC | 351958962 - (IN) THE ENDOSCOPY CENTER AT ST FRANCIS LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $840.00 | 1568918746 - ORTHOPEDIC SURGERY CENTER OF PALM BEACH COUNTY, LLC | 812594417 - (FL) ORTHOPEDIC SURGERY CENTER OF PALM BEACH COUNTY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $50.00 | 1972577161 - TAMPA FL ENDOSCOPY ASC LLC, TAMPA BAY ENDOSCOPY CENTER | 200073189 - (FL) TAMPA FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $373.00 | 1497029466 - MOUNTAIN HOME SURGERY CENTER, INC. | 454157268 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $200.00 | 1043375702 - HAZLETON ENDOSCOPY CENTER, INC. | 233074102 - (PA) HAZLETON ENDOSCOPY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $995.00 | 1730378498 - TORRANCE CA MULTISPECIALTY ASC LLC, SURGERY CENTER OF SOUTH BAY | 204259636 - (CA) TORRANCE CA MULTISPECIALTY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $995.00 | 1760533830 - GASTROINTESTINAL MEDICAL CENTER ASC | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49606 | $751.00 | 1518972322 - CASA COLINA SURGERY CENTER LLC | 300156851 - (CA) CASA COLINA SURGERY CENTER L.P. | CA | 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 49606 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49606 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 49606 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 49606. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49606 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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