CPT 49900 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 • 78 - Return to OR - related procedure • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49900 |
National average reimbursement for CPT 49900 by major payers:
$956.22
$1,085.38
$1,158.24
$1,342.97
| 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 49900 | ||||||
United | 49900 | $1424.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $994.26 | 1013984657 - MAYFAIR DIGESTIVE HEALTH CENTER, LLC | 50525982 - (WI) MAYFAIR DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $410.00 | 1679804355 - LONESTAR AMBULATORY SURGICAL CENTER | 263806076 - (TX) LONESTAR AMBULATORY SURGICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $485.00 | 1952373086 - CRYSTAL RIVER ENDOSCOPY ASC LP, CITRUS ENDOSCOPY & SURGERY CENTER | 621666148 - (FL) CRYSTAL RIVER ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $509.00 | 1437274495 - EYE SURGICAL CENTER OF SAN FRANCISCO LLC, EYE SURGERY CENTER OF SAN FRANCISCO | 203822864 - (CA) EYE SURGERY CENTER OF SAN FRANCISCO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $690.00 | 1164976478 - FRANCISCAN MEDICAL GROUP, THE DOCTORS CLINIC AMBULATORY SURGICAL CENTER, A PART OF THE FRANCISCA | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $1274.00 | 1659793040 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $494.50 | 1679612253 - WALKER SURGICAL CENTER LLC | 810635117 - (MI) WALKER SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $272.00 | 1427245257 - CENTENNIAL SURGICAL CENTER, LLC | 880499721 - CENTENNIAL SPINE & PAIN CENTER | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $2732.00 | 1457948630 - METHODIST AMBULATORY SURGERY CENTER OF LANDMARK, LLC | 842492174 - (TX) METHODIST AMBULATORY SURGERY CENTER OF LANDMARK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $138.00 | 1144406927 - SAN ANTONIO TX ENDOSCOPY ASC LP, SAN ANTONIO GASTROENTEROLOGY ENDOSCOPY CENTER NORTH | 200075829 - (TX) SAN ANTONIO TX ENDOSCOPY ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $1064.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $494.00 | 1629173075 - THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC, CROWNE POINT ENDOSCOPY & SURGERY CENTER | 352227535 - (MI) THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $1274.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 49900 | $689.00 | 1346396082 - PARKWAY SURGICAL CENTER, LLC | 911613809 - (WA) PARKWAY SURGICAL CENTER LLC | WA | 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 49900 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49900 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 49900 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 |
|---|---|---|
| 49900-CPT | Moderate | Suture Secondary Abdominal Wall |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49900. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49900 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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