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See a sample rate comparisonCPT 49904 Fee Schedule
Last Verified: October 2026
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.
Surgery For Abdominal Flap, Surgery To Create A Skin Flap Out Of Abdominal Tissue. The Procedure Leaves Part Of The Skin In Place So That It Has A Blood Supply. The Flap Is Used In Reconstructive Surgery Typically For Chest Structures.
| 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 62 - Co-Surgeons 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 49904 |
| Medicaid Fee Schedule | View Medicaid rates for 49904 |
National average reimbursement for CPT 49904 by major payers:
$1,688.87
$1,918.00
$1,983.63
$2,277.94
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CPT 49904
5 of 25 sample ratesHigher to lower in this preview
Alpine Surgicenter, LLC
$4,115.00Published ratePacific Endo-Surgical Center Lp
Pacific Endosurgical Center Lp
$1,274.00Published rateThe Polyclinic, Asc Polyclinic Surgery Center
The Polyclinic, PLLC
$1,004.00Published rateMatthews Surgery Center, LLC
Matthews Surgery Center LLC
$629.00Published rateChildrens Surgery Center, LLC
$170.00Published rate
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See a sample payer proposalCPT 49904 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49904 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 49904 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 |
|---|---|---|
| 49904-CPT | High | Surgery For Abdominal Flap, Surgery To Create A Skin Flap Out Of Abdominal Tissue. The Procedure Leaves Part Of The Skin In Place So That It Has A Blood Supply. The Flap Is Used In Reconstructive Surgery Typically For Chest Structures. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49904 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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