CPT 49617 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49617 |
National average reimbursement for CPT 49617 by major payers:
$1,120.02
$1,262.56
$1,210.34
$1,505.55
| 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 49617 | ||||||
United | 49617 | $2200.00 | 1982674065 - HEMET HEALTHCARE SURGICENTER, INC. | 330526203 - (CA) HEMET HEALTHCARE SURGICENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $12899.00 | 1396774543 - WISCONSIN SURGERY CENTER LLC | 383661215 - (WI) WISCONSIN SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $822.00 | 1649662206 - ADVANCED SURGERY CENTER OF ARIZONA, LLP, ADVANCED SURGERY CENTER OF ARIZONA | 471883984 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $1369.00 | 1073516795 - SPRING PARK SURGERY CENTER L L C | 421483989 - (IA) SPRING PARK SURGERY CENTER, LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $3225.00 | 1356412894 - ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | 364513047 - (IL) ROCKFORD ORTHOPEDIC SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $1787.00 | 1902020522 - ROME SURGICAL CENTER, P.C. | 208847972 - (GA) ROME SURGICAL CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $3435.00 | 1922542745 - NORTH TEXAS SURGERY CENTER, LLC | 813775233 - (TX) NORTH TEXAS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $3200.00 | 1144845116 - LEGACY CENTER FOR SPINAL SURGERY, LLC | 843166515 - (GA) LEGACY CENTER FOR SPINAL SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $6365.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $4162.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $2441.00 | 1083601298 - LAHAYE CENTER FOR ADVANCED EYE CARE, APMC, LAHAYE EYE CLINIC | 720988221 - (LA) LAHAYE EYE CLINIC, P.C. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $2600.00 | 1285825075 - SUNNYSIDE SURGERY CENTER, LLC | 201164055 - (ID) SUNNYSIDE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $3474.00 | 1053560896 - ASC DEVELOPMENT COMPANY, LLC, NATIONAL SPINE AND PAIN CENTERS | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $1529.00 | 1386820694 - URO-CENTER AMBULATORY SURGICAL CENTER LLC | 522267795 - (MD) UROCENTER AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49617 | $1118.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 261261804 | AZ | 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 49617 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49617 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 49617 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 |
| 49617-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); Greater Than 10 Cm, Reducible |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49617. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49617 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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