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See a sample rate comparisonCPT 49615 Fee Schedule
Last Verified: October 2026
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.
Rpr Aa Hrn Rcr 3 10 Rdc, 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
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49615 |
| Medicaid Fee Schedule | View Medicaid rates for 49615 |
National average reimbursement for CPT 49615 by major payers:
$836.04
$912.41
$859.28
$1,051.72
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CPT 49615
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$10,099.00Published rateTexan Ambulatory Surgery Center, Lp
$3,570.00Published rateLegent Outpatient Surgery Singing Hills, LLC, Legent Outpatient Surgery Singing Hills
Legent Outpatient Surgery Singing Hills LLC
$2,277.00Published rateBay Area Asc LLC, Azura Surgery Center Houston
Bay Area Asc LLC
$1,685.00Published rateKingsley Endoscopy Center LLC
$1,009.00Published rate
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See a sample payer proposalCPT 49615 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49615 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 49615 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 | Rpr Aa Hrn Rcr 3 Rdc, 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 | Rpr Aa Hrn Rcr 3 Ncr Strn, 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 | Rpr Aa Hrn Rcr 3 10 Rdc, 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 | Rpr Aa Hrn Rcr 3 10 Ncr Strn, 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 49615. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49615 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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