CPT 49616 Fee Schedule
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.
| 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 |
| CMS | $835.19 Physician Fee Schedule |
National average reimbursement for CPT 49616 by major payers:
$1,102.92
$1,225.36
$1,146.01
$1,460.13
| 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 49616 | ||||||
United | 49616 | $7621.00 | 1902959190 - RIVA ROAD SURGICAL CENTER, LLC | 870774597 - (MD) RIVA ROAD SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $3375.00 | 1508199720 - NEWBRIDGE SURGERY CENTER AT FREDERICK | 264650604 - (MD) NEWBRIDGE SURGERY CENTER AT FREDERICK | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $3800.00 | 1174571970 - DCR SURGERY CENTER, LLC | 200019313 - (OH) DCR SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $4189.00 | 1457784852 - SMART PAIN SURGERY CENTER AT OWINGS MILLS, LLC, CLEARWAY SURGERY CENTER OF OWINGS MILLS | 454995677 - (MD) SMART PAIN SURGERY CENTER AT OWINGS MILLS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $1606.00 | 1477698454 - REGIONAL EYE SURGERY CENTER,LLC | 721484653 - (LA) REGIONAL EYE SURGERY CENTER, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $1962.00 | 1538153994 - SOUTH FLORIDA CENTER FOR ENDOSCOPY & DIGESTIVE DISEASE LLC, KENDALL ENDOSCOPY & SURGERY CENTER | 651112489 - (FL) SOUTH FLORIDA CENTER FOR ENDOSCOPY & DIGESTIVE DISEASE, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $6588.00 | 1275682627 - SUMMIT VIEW SURGERY CENTER, LLC | 20659552 - (CO) SUMMIT VIEW SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $1062.00 | 1235285628 - DAYTON EYE SURGERY CENTER L.L.C., DAYTON EYE SURGERY CENTER | 311596557 - (OH) DAYTON EYE SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $6087.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $6010.00 | 1487246229 - PRESBYTERIAN RUST MEDICAL CENTER ASC LLC, NEW MEXICO SURGERY CENTER-MULTI SPECIALTY | 861495452 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $1523.00 | 1306924170 - DELMAR SURGICAL CENTER LLC | 621717312 - (MD) DELMAR SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $1100.00 | 1780958207 - LANCASTER SURGERY CENTER, INC. | 320361416 - (OH) LANCASTER SURGERY CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $2231.00 | 1578077103 - SNNAC LLC, AZURA SURGERY CENTER NORTHERN NEVADA | 821669704 - (NV) SNNAC LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $3000.00 | 1023151974 - DEL MAR SURGERY CENTER | 330869192 - (CA) DEL MAR SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49616 | $3232.00 | 1578914891 - DH PHYSICIANS AMBULATORY SERVICES | 812885619 | PA | 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 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 | 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 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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