CPT 10005 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 10005 by major payers:
$161.61
$167.58
$170.01
$226.36
| 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 10005 | ||||||
United | 10005 | $102.19 | 1508855651 - TERRY SWEATT | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 10005 | $222.44 | 1821288499 - DURGA VEDATI | 350593390 - DEACONESS HOSPITAL INC | TX | Family Medicine Physician (207Q00000X) |
United | 10005 | $152.03 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 10005 | $152.03 | 1134127301 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 10005 | $152.03 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 10005 | $183.96 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 10005 | $222.44 | 1902850068 - CHONG NICHOLLS | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 10005 | $222.44 | 1043451727 - BHARGAV TRIVEDI | 350593390 - DEACONESS HOSPITAL INC | IN | Neurology Physician (2084N0400X) |
United | 10005 | $222.44 | 1578527263 - EDWARD MOORE | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 10005 | $222.44 | 1962076034 - VARINDER BANSRO | 350593390 - DEACONESS HOSPITAL INC | MD | Internal Medicine Physician (207R00000X) |
United | 10005 | $3853.00 | 1619031416 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 10005 | $222.44 | 1801091269 - MICHELLE HAUCK | 350593390 - DEACONESS HOSPITAL INC | WI | Internal Medicine Physician (207R00000X) |
United | 10005 | $222.44 | 1386091767 - DAVID CORADIN | 350593390 - DEACONESS HOSPITAL INC | FL | Geriatric Medicine (Internal Medicine) Physician (207RG0300X) |
United | 10005 | $222.44 | 1316407596 - VICKY SANDHU | 350593390 - DEACONESS HOSPITAL INC | CA | Hospitalist Physician (208M00000X) |
United | 10005 | $3853.00 | 1922036805 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
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 10005 vs. Other General Surgical Procedures Codes
The CPT 10005 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 10005 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 10005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 10005 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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