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 | Low |
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 | $91.65 | 1659963510 - THOMAS HORNYAK | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
United | 10004 | $217.00 | 1679696157 - ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES, LLC, SLOCUM AMBULATORY SURGERY CENTER | 770590285 - (OR) ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $125.00 | 1619923661 - DELTA ENDOSCOPY CENTER, P.C. | 640903701 - (MS) DELTA ENDOSCOPY CENTER PC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $89.00 | 1811385883 - CENTRAL DELAWARE ENDOSCOPY UNIT LLC | 471840129 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $300.00 | 1902043284 - AESTHETIC & GENERAL DERMATOLOGY OF SEATTLE | 911886576 - (WA) ELIE LEVY, M.D., P.C. DBA AESTHETIC & GENERAL DERMATOLOGY OF SEATTLE | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $150.00 | 1790237501 - AMERICAN ACCESS CARE OF SP ASC LLC | 814086575 - (PA) AMERICAN ACCESS CARE OF SP ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $91.65 | 1396001103 - PEARL QUARTEY-KUMAPLEY | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
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 | $1250.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $100.00 | 1881276319 - TEXARKANA PAIN SURGERY CENTER LLC | 844941902 - (AR) TEXARKANA PAIN SURGERY CENTER LLC | AR | 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 | $115.00 | 1407812860 - THE SURGICAL CENTER OF THE TREASURE COAST, LLC | 371446353 - (FL) SURGICAL CENTER OF THE TREASURE COAST | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $254.00 | 1104125939 - GASTROENTEROLOGY CARE INC | 263101232 - (NY) GASTROENTEROLOGY CARE INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $702.00 | 1225091739 - OUTPATIENT WOMEN'S AND CHILDREN'S SURGERY CENTER, LTD | 432016059 - (TX) OUTPATIENT WOMENS AND CHILDRENS SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10004 | $100.00 | 1063853174 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA THE VILLAGES | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | 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 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-CPT | Low | Fine Needle Aspiration Biopsy, Without Imaging Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10005-CPT | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; First Lesion |
| 10006-CPT | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10007-CPT | 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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