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See a sample rate comparisonCPT 49999 Fee Schedule
Last Verified: October 2026
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.
Unlisted Proc Abdom Peritoneum & Omentum, Unlisted Procedure Abdomen Peritoneum And Omentum
| 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 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 49999 |
| Medicaid Fee Schedule | View Medicaid rates for 49999 |
National average reimbursement for CPT 49999 by major payers:
$506.71
$276.49
$4,113.00
$1,122.07
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CPT 49999
5 of 25 sample ratesHigher to lower in this preview
Ochsner Medical Center, Ochsner Outpatient Surgery Suite
Ochsner Clinic Foundation
$3,825.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Scottsdale
Surgery Center Of Scottsdale LLC
$1,258.00Published rateWoodbury Surgery Center, LLC
Woodbury Surgery Center LLC
$1,143.00Published rateSacramento Heart Ambulatory Surgery Center, Inc
Sacramento Heart Ambulatory Surgery Center Inc
$700.00Published rateMelbourne Asc Lp, The Surgery Center Of Melbourne
Melbourne Asc Lp
$410.00Published rate
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See a sample payer proposalCPT 49999 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 49999 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 49999 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 |
|---|---|---|
| 49906-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. |
| 49999-CPT | Moderate | Unlisted Proc Abdom Peritoneum & Omentum, Unlisted Procedure Abdomen Peritoneum And Omentum |
| 50010-CPT | Moderate | Exploration Renal |
| 50020-CPT | High | Drain Abscess Renal/Perirenal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 49999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 49999 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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