CPT 10012 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 • 23 - Emergency Room |
| Common Modifiers | • None • 26 - Professional component • 95 - Telemedicine - audio and video • 62 - Co-Surgeons • 52 - Reduced Services • RT - Right side of body • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 10012 by major payers:
$246.63
$296.66
$217.20
$347.97
| 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 10012 | ||||||
United | 10012 | $176.00 | 1518373695 - HOLLYWOOD SURGICAL CENTER, LLC | 462573171 - (FL) HOLLYWOOD SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $77.00 | 1811932270 - PHILADELPHIA SURGI CENTER, INC. | 232965126 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $552.00 | 1396896684 - DREYER AMBULATORY SURGERY CENTER, LLC | 363890298 - (IL) DREYER AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $401.00 | 1093079196 - MERCY HOSPITALS EAST COMMUNITIES, MERCY OUTPATIENTSURGERY CENTER WASHINGTON | 431066883 - (MO) MERCY HOSPITALS EAST COMMUNITIES | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $60.00 | 1487779435 - LAKEFOREST AMBULATORY SURGERY CENTER, DISTRICT HEIGHTS AMBULATORY SURGERY CENTER | 521944179 - (MD) LAKEFOREST AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $688.00 | 1992827992 - ATHERTON PLASTIC SURGERY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $172.00 | 1821485442 - ALLEGHENY HEALTH NETWORK SURGERY CENTER | 473690355 - (PA) ALLEGHENY HEALTH NETWORK SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $534.00 | 1225648470 - UCSD AMBULATORY SURGERY CENTER, LLC | 261232189 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $1187.00 | 1215060546 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $162.00 | 1558926931 - WELLNESS AMBULATORY SURGERY CENTER, LLC | 810848308 - (TX) WELLNESS AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $102.00 | 1922280197 - NORTH OAK AMBULATORY SURGERY CENTER, LLC | 261479859 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $403.00 | 1356099147 - HOPCO FLAGSTAFF ASC HOLDINGS, LLC, ELEVATION SURGERY CENTER | 851224752 - (AZ) HOPCO FLAGSTAFF ASC HOLDINGS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $500.00 | 1841284742 - KLEINERT KUTZ SURGERY CENTER, LLC | 352095662 - (IN) KLEINERT KUTZ SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $2228.00 | 1184900102 - METROPOLITAN NEW JERSEY, LLC, METROPOLITAN SURGERY CENTER | 453003521 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10012 | $83.00 | 1306043617 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | 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 10012 vs. Other General Surgical Procedures Codes
The CPT 10012 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 10012 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) |
| 10012 | Moderate | Fine Needle Aspiration Biopsy Including Mr Guidance; Each Additional Lesion (List Separately 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 10012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 10012 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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