CPT 49613 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49613 |
National average reimbursement for CPT 49613 by major payers:
$527.34
$601.36
$570.86
$724.29
| 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 49613 | ||||||
United | 49613 | $3623.00 | 1942472931 - SURGCENTER OF GLEN BURNIE, SURGCENTER OF GLEN BURNIE, LLC | 261572774 - (MD) SURGCENTER OF GLEN BURNIE, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $3623.00 | 1295775369 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE EDMONDS CENTER FOR OUTPATIENT SURGERY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $2204.00 | 1265679674 - GEORGIA UROLOGY FAYETTE ASC | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $3176.00 | 1609907211 - SHREWSBURY SURGERY CENTER, LLC, SHREWSBURY SURGERY CENTER | 223651945 - (NJ) SHREWSBURY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $1850.00 | 1750694832 - SURGICARE ASSOCIATES, LLC | 272802420 - (PA) SURGICARE ASSOCIATES LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $2175.00 | 1275629081 - VISION CARE OF MAINE LLC | 10525143 - (ME) VISION CARE OF MAINE LLC | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $1802.00 | 1821420571 - UPPER VALLEY SURGERY CENTER | 462617367 - (ID) UPPER VALLEY SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $2154.00 | 1093461410 - INFIRMARY ASC | 871933440 - (AL) INFIRMARY ASC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $758.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $2795.00 | 1558524298 - SAINT FRANCIS GI ENDOSCOPY L.L.C | 205540278 - (CT) SAINT FRANCIS GI ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $1410.00 | 1902834922 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $3623.00 | 1861071250 - ADVENTHEALTH SURGERY CENTER MILLS PARK LLC, ADVENTHEALTH SURGERY CENTER MILLS PARK | 832780608 - (FL) ADVENTHEALTH SURGERY CENTER MILLS PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $1319.00 | 1699429415 - ST LUKE'S SURGERY CENTER, LLC | 873243012 - A POSITIVE FOCUS COUNSELING LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $1630.00 | 1417958729 - MENTOR SURGERY CENTER LTD | 341863257 - (OH) MENTOR SURGERY CENTER,LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49613 | $2070.00 | 1124484019 - EDISON SURGERY CENTER LLC | 475016492 - (NJ) EDISON SURGERY CENTER LLC | NJ | 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 49613 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49613 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 49613 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 |
|---|---|---|
| 49613-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Recurrent, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); Less Than 3 Cm, Reducible |
| 49614-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Recurrent, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); Less Than 3 Cm, Incarcerated Or Strangulated |
| 49615-CPT | Moderate | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Recurrent, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); 3 Cm To 10 Cm, Reducible |
| 49616-CPT | High | Repair Of Anterior Abdominal Hernia(S) (Ie, Epigastric, Incisional, Ventral, Umbilical, Spigelian), Any Approach (Ie, Open, Laparoscopic, Robotic), Recurrent, Including Implantation Of Mesh Or Other Prosthesis When Performed, Total Length Of Defect(S); 3 Cm To 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 49613. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49613 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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