CPT 49615 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 • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $622.02 Physician Fee Schedule |
National average reimbursement for CPT 49615 by major payers:
$836.04
$912.41
$859.28
$1,090.64
| 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 49615 | ||||||
United | 49615 | $2202.00 | 1275719981 - SURGERY CENTER OF KEY WEST LLC | 205854803 - (FL) SURGERY CENTER OF KEY WEST LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $7825.00 | 1063659605 - HOWARD COMMUNITY SURGERY CENTER LLC | 352118748 - (IN) HOWARD COMMUNITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $6342.00 | 1972878726 - WILSON CREEK SURGICAL CENTER, LLC, STONEBRIDGE SURGERY CENTER | 274816583 - (TX) WILSON CREEK SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $1704.00 | 1336112200 - MERCER COUNTY SURGERY CENTER LLC, MERCER COUNTY SURGERY CENTER | 223774069 - (NJ) MERCER COUNTY SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $3570.00 | 1336142413 - TEXAN AMBULATORY SURGERY CENTER, LP | 331058382 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $1730.00 | 1386652667 - MACON OUTPATIENT SURGERY, LLC | 203027560 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $2689.00 | 1912678947 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $1200.00 | 1821010638 - CATARACT AND LASER CENTER LLC | 522066053 - (DE) CATARACT AND LASER CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $1678.00 | 1508360181 - NEPHROLOGY VASCULAR LAB OF CENTRAL ALABAMA ASC LLC | 815281505 - (AL) NEPHROLOGY VASCULAR LAB OF CENTRAL ALABAMA ASC LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $712.00 | 1457331274 - MONTGOMERY EYE SURGERY CENTER LLC, THE MONTGOMERY EYE SURGERY CENTER | 621607284 - (AL) MONTGOMERY EYE SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $4339.00 | 1942617477 - CENTER FOR ENDOSCOPY LLC | 464958743 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $16288.00 | 1063735702 - OCHSNER MEDICAL CENTER, OCHSNER OUTPATIENT SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $3623.00 | 1952333882 - THE MARYLAND CENTER FOR DIGESTIVE HEALTH LLC | 470856276 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $2500.00 | 1366643751 - SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, L.P. | 205991988 - (CA) SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49615 | $3000.00 | 1770559759 - RALEIGH PLASTIC SURGERY CENTER INC | 561067994 - (NC) RALEIGH PLASTIC SURGERY CENTER, INC. | NC | 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 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 | 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 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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