CPT 0055T 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 | • Category III Codes • Various Services - Category III Codes |
| Complexity Level | Moderate |
National average reimbursement for CPT 0055T by major payers:
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| 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 0055T | ||||||
United | 0055T | $131.99 | 1265663777 - KRISTI L CONWAY DPM PA, BAY AREA PODIATRY CENTER | 264709089 - (FL) KRISTI L CONWAY DPM PA | FL | Podiatrist (213E00000X) |
United | 0055T | $131.99 | 1205051745 - DALE R. MONAST | 461919327 - (FL) DALE R. MONAST, D. P. M. , P.L.L.C. | FL | Podiatrist (213E00000X) |
United | 0055T | $143.78 | 1720037138 - PREFERRED PODIATRY GROUP PC | 363885637 - PREFERRED PODIATRY GROUP, P.C. | OH | Podiatrist (213E00000X) |
United | 0055T | $557.17 | 1306893151 - WILLIAM COTTRELL | 592929608 - (FL) MUSCULOSKELETAL INSTITUTE INC. FLORIDA ORTHOPAEDIC INSTITUTE | FL | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
United | 0055T | $924.71 | 1144430125 - BENJAMIN BROWN | 720276883 | LA | Neurological Surgery Physician (207T00000X) |
United | 0055T | $300.17 | 1528448412 - APRIL NELSON | 346004382 | OH | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 0055T | $245.25 | 1477896215 - MATTHEW MARTINCEVIC | 593214635 - FLORIDA HOSPITAL MEDICAL GROUP INC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 0055T | $441.45 | 1811003593 - SAMUEL YOUNG | 541060357 - (VA) DOMINION HEALTH MEDICAL ASSOCIATES, LTD | NC | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
United | 0055T | $287.54 | 1184955734 - BENJAMIN FOX | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | 0055T | $131.66 | 1285984104 - MARTHA HERRERA | 460863659 | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 0055T | $94.65 | 1669433447 - MICHAEL LEIGHTON | 650327403 - (FL) PALM BEACH ORTHOPAEDIC INSTITUTE, P.A. | FL | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
United | 0055T | $130.78 | 1578569380 - DENISE NEGRON | 262695566 | FL | Podiatrist (213E00000X) |
United | 0055T | $365.85 | 1760845879 - RACHEAL PETERSON | 462021581 - (FL) FLORIDA HOSPITAL PHYSICIAN GROUP INC | LA | Neurological Surgery Physician (207T00000X) |
United | 0055T | $122.01 | 1942667654 - GABRIEL SANTAMARINA | 593509645 - (FL) ALL PODIATRY GROUP, INC. | GA | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 0055T | $244.02 | 1508124439 - CONOR GARRY | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | VA | Orthopaedic Trauma Physician (207XX0801X) |
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 0055T vs. Other Various Services - Category III Codes Codes
The CPT 0055T code is part of the Category III Codes services used for Various Services - Category III Codes. 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 0055T 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 |
|---|---|---|
| 0055T-CPT | Moderate | Computer Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure With Image-Guidance Based On Ct And Mri Images (List Separatly 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 0055T. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 0055T 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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