CPT 49618 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 • 22 - Increased Procedural Services • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49618 |
National average reimbursement for CPT 49618 by major payers:
$1,650.22
$1,768.90
$1,696.75
$2,103.12
| 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 49618 | ||||||
United | 49618 | $2854.00 | 1598339392 - COPPER CITY SURGERY CENTER, PLLC | 831039743 - (MT) COPPER CITY SURGERY CENTER PLLC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $4818.00 | 1558627406 - CARMEL SPECIALTY SURGERY CENTER LLC | 454729527 - (IN) CARMEL SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $5833.00 | 1649501073 - SHORE HEALTH SYSTEM, INC., SHORE HEALTH SYSTEM SURGERY CENTER | 520610538 - (MD) SHORE HEALTH SYSTEM INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $2824.00 | 1477724250 - THE PHYSICIANS ROME SURGERY CENTER | 205942007 - (GA) THE PHYSICIANS ROME SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $2764.00 | 1497740872 - SHASTA EYE SURGEONS INC, SURGERY CENTER OF NORTHERN CALIFORNIA | 205757123 - (CA) SHASTA EYE SURGEONS INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $3275.00 | 1619291192 - DALLAS IVF SURGERY CENTER, LLC, DALLAS IVF SURGERY CENTER | 263473774 - (TX) DALLAS IVF SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $4664.00 | 1790752061 - NORTH FLORIDA REGIONAL FREESTANDING SURGERY CENTER LP | 621460781 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $3474.00 | 1114491073 - ASC DEVELOPMENT COMPANY LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $7621.00 | 1245820042 - ALOE SURGICAL CENTER SCOTTSDALE, LLC | 845112576 - (AZ) ALOE SURGICAL CENTER SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $3489.00 | 1386647402 - PHYSICIANS DAY SURGERY CENTER, LLC, PHYSICIANS DAY SURGERY CENTER, INC. | 593438026 - (FL) PHYSICIANS DAY SURGERY CENTER, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $3991.00 | 1679022636 - NORTHWEST COMMUNITY FOOT AND ANKLE CENTER LLC | 352567039 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $6588.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 843623972 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $3565.00 | 1073509733 - WEST PLAINS SURGERY CENTER LLC | 320093110 - (MO) WEST PLAINS AMBULATORY SURGERY CENT | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $7229.00 | 1003058744 - YORK COUNTY ENDOSCOPY CENTER LLC | 463366385 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49618 | $1755.00 | 1336112200 - MERCER COUNTY SURGERY CENTER LLC, MERCER COUNTY SURGERY CENTER | 223774069 - (NJ) MERCER COUNTY SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 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 49618 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49618 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 49618 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 |
| 49618-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, 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 49618. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49618 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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