CPT 49623 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $196.67 Physician Fee Schedule |
National average reimbursement for CPT 49623 by major payers:
$255.96
$281.48
$270.21
$344.48
| 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 49623 | ||||||
United | 49623 | $180.00 | 1265816003 - CLEARVIEW SURGERY CENTER, LLC | 474123527 - (ID) CLEARVIEW SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $688.00 | 1083938765 - MEDICAL PARK TOWER SURGERY CENTER, LLC, MEDICAL PARK TOWER SURGERY CENTER | 270543475 - (TX) MEDICAL PARK TOWER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $1042.00 | 1932164852 - MAY STREET SURGI CENTER, LLC, MAY STREET SURGI CENTER | 223777533 - (NJ) MAY STREET SURGI CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $225.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $491.00 | 1467010736 - MERCY SURGERY CENTER LLC | 841875159 - (IA) MERCY SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $411.00 | 1760440515 - SIERRA ENDOSCOPY CENTER, LLC | 680482297 - (CA) SIERRA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $555.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $118.00 | 1407169212 - GEORGIA SPINE SURGERY CENTER, LLC, GNS SURGERY CENTER | 271111856 - (GA) GEORGIA SPINE SURGERY CENTER, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $106.00 | 1427051796 - SOUTH BEND IN ENDOSCOPY ASC LLC, MICHIANA ENDOSCOPY CENTER | 352011366 - (IN) SOUTH BEND IN ENDOSCOPY ASC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $328.00 | 1063996734 - COASTAL ENDO, LLC, COASTAL ENDOSCOPY CENTER | 831370400 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $574.00 | 1720530405 - GRAND RAPIDS SURGICAL SUITES LLC | 811321919 - (MI) GRAND RAPIDS SURGICAL SUITES, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $530.00 | 1093352908 - BAPTIST HEALTHCARE SYSTEM, INC., BAPTIST HEALTH SURGERY CENTER EASTPOINT | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $183.00 | 1467458281 - EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC, EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE | 201344254 - (FL) EYE CARE AND SURGERY CENTER OF FT LAUDERDALE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $52.00 | 1558720235 - DHCH LLC | 811030907 - (NY) DHCH, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49623 | $375.00 | 1265488563 - SYRACUSE ASC, LLC, SPECIALTY SURGERY CENTER OF CNY | 161549512 - (NY) SPECIALTY SURGERY CENTER OF CNY | NY | 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 49623 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49623 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 49623 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 |
|---|---|---|
| 49621-CPT | Moderate | Repair Of Parastomal Hernia, Any Approach (Ie, Open, Laparoscopic, Robotic), Initial Or Recurrent, Including Implantation Of Mesh Or Other Prosthesis, When Performed; Reducible |
| 49622-CPT | High | Repair Of Parastomal Hernia, Any Approach (Ie, Open, Laparoscopic, Robotic), Initial Or Recurrent, Including Implantation Of Mesh Or Other Prosthesis, When Performed; Incarcerated Or Strangulated |
| 49623-CPT | Moderate | Removal Of Total Or Near Total Non-Infected Mesh Or Other Prosthesis At The Time Of Initial Or Recurrent Anterior Abdominal Hernia Repair Or Parastomal Hernia Repair, Any Approach (Ie, Open, Laparoscopic, Robotic) (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49623. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49623 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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