CPT 49659 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 • RT - Right side of body • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 49659 by major payers:
$1,187.46
$319.21
$1,246.27
$1,408.37
| 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 49659 | ||||||
United | 49659 | $2433.00 | 1194275230 - WEST SUBURBAN EYE SURGERY CENTER LLC, SURGISITE NORTH | 201671234 - (MA) WEST SUBURBAN EYE SURGERY CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $3015.00 | 1437623626 - PRIME SURGICAL SUITES, LLC, SCSV, LLC | 463556921 - (NC) PRIME SURGICAL SUITES LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $965.00 | 1457320962 - FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC. | 522160415 - (MD) FOOT AND ANKLE CENTER AT THE BURKLAND MEDICAL CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1808.00 | 1215263082 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WFUBMC ENDOSCOPY CENTER | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1950.00 | 1396702528 - TALLAHASSEE NEUROSUGERY PAIN MANAGEMENT LLC, TALLAHASSEE MEMORIAL CENTER FOR PAIN MANAGEMENT | 200307088 - (FL) TALLAHASSEE NEUROSUGERY PAIN MANAGEMENT LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1675.00 | 1023010311 - BLUE RIDGE SURGICAL CENTER, LLC | 141854493 - (MO) BLUE RIDGE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1420.00 | 1952464844 - EDWARDSVILLE AMBULATORY SURGERY CENTER LLC | 371343371 - (IL) EDWARDSVILLE AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $5020.00 | 1558879684 - DELAWARE RIVER SURGICAL SUITES, LLC | 822713553 - (PA) BUCKS COUNTY SURGICAL SUITES | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1233.00 | 1225039761 - ENDOSCOPY CENTER OF ST THOMAS LLC, ST THOMAS MEDICAL GROUP ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1801.00 | 1265437743 - REGIONAL UROLOGY ASC LLC | 721455456 - (LA) REGIONAL UROLOGY ASC LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $4200.00 | 1679913552 - SPINE SPORTS SURGERY CENTER, LLC, SPINE AND SPORTS SURGERY CENTER | 461141188 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $8238.00 | 1396700407 - ARLINGTON SURGERY CENTER, LLC, ARLINGTON SURGERY CENTER ASSOCIATES, LP | 752055800 - (TX) ARLINGTON SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $5040.00 | 1962423574 - FULLERTON SURGICAL CENTER, LP, FULLERTON SURGICAL CENTER | 470927394 - (CA) FULLERTON SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $3421.00 | 1508318411 - INTERVENTIONAL SPINE CENTER, LLC | 263161503 - (CA) INTERVENTIONAL SPINE CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49659 | $1947.00 | 1588640353 - ENT REALTY CORP, THE SURGERY CENTER | 351846420 - (IN) ENT REALTY CORP | IN | 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 49659 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49659 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 49659 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 |
|---|---|---|
| 49659-CPT | High | Unlisted Laparoscopy Procedure, Hernioplasty, Herniorrhaphy, Herniotomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49659. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49659 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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