CPT 49611 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 | • 21 - Inpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49611 |
National average reimbursement for CPT 49611 by major payers:
$795.27
$810.22
$843.80
$998.82
| 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 49611 | ||||||
United | 49611 | $473.00 | 1093368151 - DESERT PEAKS SURGERY CENTER LLC | 842431154 - (NM) DESERT PEAKS SURGERY CENTER LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $100.00 | 1841259611 - ALTA-ROSE SURGERY CENTER LLC | 201429557 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $775.00 | 1134779622 - HELIX SURGICENTER LLC | 834455797 - (IN) HELIX SURGICENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $523.00 | 1528297140 - ISPM ASC AT COVINGTON, LLC | 264485600 - (GA) ISPM ASC AT COVINGTON LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $463.00 | 1356099147 - HOPCO FLAGSTAFF ASC HOLDINGS, LLC, ELEVATION SURGERY CENTER | 851224752 - (AZ) HOPCO FLAGSTAFF ASC HOLDINGS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $842.00 | 1639669476 - UCHEALTH AMBULATORY SURGERY CENTERS, LONGS PEAK SURGERY CENTER, LLC | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $2795.00 | 1255787867 - THE METROHEALTH SYSTEM, METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | 346004382 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $1039.00 | 1780764829 - NOVAMED SURGERY CENTER OF ST PETERS LLC, ST PETERS AMBULATORY SURGERY CENTER | 205579933 - (MO) NOVAMED SURGERY CENTER OF ST PETERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $644.00 | 1356421853 - PINEHURST MEDICAL CLINIC INC, PINEHURST MEDICAL CLINIC ENDOSCOPY CENTER | 560942980 - (NC) PINEHURST MEDICAL CLINIC, INC. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $509.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $2692.00 | 1023071180 - SAHARA OUTPATIENT SURGERY CENTER LTD | 752509486 - (NV) SAHARA OUTPATIENT SURGERY CENTER LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $400.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $1274.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $1955.00 | 1982607446 - DENTON SURGICARE PARTNERS, LTD., DENTON SURGICARE | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49611 | $13332.00 | 1679577167 - WHITEHALL SURGERY CENTER, LTD, PICKERINGTON SURGERY CENTER | 311479613 | OH | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 49611 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49611 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 49611 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 |
| 49611-CPT | Moderate | Rep Omphalocele Gross Type 2nd Stg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49611. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49611 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 49611) and we'll show you how you compare in 15 minutes or less.