CPT 10004 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 • General Surgical Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 10004 by major payers:
$64.55
$68.68
$61.09
$96.64
| 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 10004 | ||||||
United | 10004 | $531.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $618.00 | 1144200163 - ABILENE ASC LP, ABILENE ENDOSCOPY CENTER | 621562008 - (TX) ABILENE ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $474.00 | 1568445062 - EYE SURGERY & LASER CENTER OF WISCONSIN LLC | 461222222 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $891.00 | 1861405607 - CEDAR PARK SURGERY CENTER LLP, HILL COUNTRY AMBULATORY SURGERY CENTER | 202829728 - (TX) CEDAR PARK SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $123.00 | 1740787068 - CLEVELAND CLINIC FLORIDA (A NONPROFIT CORPORATION), CLEVELAND CLINIC FLORIDA CORAL SPRINGS ASC | 650003177 - CLEVELAND CLINIC FLORIDA A NONPROFIT CORPORATION | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $150.00 | 1730876210 - MEDICAL CITY SURGERY CENTER NORTH TEXAS, LLC | 923326615 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $44.00 | 1346270428 - BALTIMORE AMBULATORY CENTER FOR ENDOSCOPY | 521913193 - (MD) BALTIMORE AMBULATORY CENTER FO | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $42.11 | 1962641431 - LARESSA BAZZELL | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 10004 | $474.00 | 1871847319 - WISCONSIN LASER AND SURGERY CENTER LLC | 461222222 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $555.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $91.65 | 1841228822 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 10004 | $254.00 | 1104125939 - GASTROENTEROLOGY CARE INC | 263101232 - (NY) GASTROENTEROLOGY CARE INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $277.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $79.00 | 1902213432 - COBBLESTONE SURGERY CENTER, INC. | 464241477 - (GA) COBBLESTONE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $91.65 | 1659963510 - THOMAS HORNYAK | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
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 10004 vs. Other General Surgical Procedures Codes
The CPT 10004 code is part of the Surgery services used for General Surgical Procedures. 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 10004 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 |
|---|---|---|
| 10004 | Low | Fine Needle Aspiration Biopsy, Without Imaging Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10005 | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; First Lesion |
| 10006 | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10007 | Moderate | Fine Needle Aspiration Biopsy Including Fluoro- Scopic Guidance; First Lesion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 10004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 10004 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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