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See a sample rate comparisonCPT 49616 Fee Schedule
Last Verified: October 2026
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.
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
| 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 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49616 |
| Medicaid Fee Schedule | View Medicaid rates for 49616 |
National average reimbursement for CPT 49616 by major payers:
$1,102.92
$1,225.36
$1,146.01
$1,407.56
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CPT 49616
5 of 25 sample ratesHigher to lower in this preview
North Cypress Surgicenter, LLC, North Cypress Surgery Center
North Cypress Surgicenter LLC
$7,797.00Published rateJackson Heart And Vascular Center LLC
$3,500.00Published rateGeorgia Lithotripsy And Laser Center
$2,529.00Published rateLancaster Surgery Center, Inc.
Lancaster Surgery Center Inc
$1,100.00Published rateOphthalmic Outpatient Surgery Center Partners, LLC, Outpatient Surgery Center For Sight
Ophthalmic Outpatient Surgery Center Partners LLC
$434.00Published rate
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See a sample payer proposalCPT 49616 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49616 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 49616 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 49616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49616 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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