CPT 12004 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 • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 23 - Emergency Room • 20 - Urgent Care Facility |
| Common Modifiers | • None • AG - Primary physician • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 12004 by major payers:
$168.55
$181.29
$186.15
$219.81
| 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 12004 | ||||||
United | 12004 | $51.00 | 1770802555 - FAIRLAWN SURGERY CENTER, LLC | 271762713 - (VA) FAIRLAWN SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $149.00 | 1386677326 - INLAND EYE SPECIALISTS A MEDICAL CORP, INLAND EYE SPECIALISTS | 330585144 - (CA) INLAND EYE SPECIALISTS, A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $312.00 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $334.00 | 1053835983 - GROUP SURGICAL PARTNERS INTEGRATED LLC, LEGENT OUTPATIENT SURGERY - FRISCO | 821249116 - (TX) GROUP SURGICAL PARTNERS INTEGRATED LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $589.38 | 1649392242 - ST. CLAIR MEMORIAL HOSPITAL | 251010303 - (PA) ST CLAIR HEALTH CORPORATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $239.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $222.13 | 1912987363 - DAVID SCHULTZ | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 12004 | $140.00 | 1306993464 - PACIFIC HILLS SURGERY CENTER LLC | 800180491 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $134.00 | 1689605826 - LAUREL SURGERY & ENDOSCOPY CENTER, LLC | 412044822 - (MS) LAUREL SURGERY AND ENDOSCOPY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $102.05 | 1629514096 - ANTHONY FOREMAN | 350593390 - DEACONESS HOSPITAL INC | TN | Certified Registered Nurse Anesthetist (367500000X) |
United | 12004 | $104.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $222.13 | 1225328271 - ALEXIS HUYNH | 350593390 - DEACONESS HOSPITAL INC | NY | Hospitalist Physician (208M00000X) |
United | 12004 | $215.00 | 1437501145 - NORTH CARE ASC, LLC | 810851059 - (CO) NORTH CARE ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $606.00 | 1215111869 - SPECIALTY SURGERY CENTER AT FOUNTAIN VALLEY REGIONAL HOSPITAL LLC | 371756991 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12004 | $703.00 | 1164870895 - SUMMIT ORTHOPEDICS LTD, EAGAN SURGERY CENTER | 411762331 - SUMMIT ORTHOPEDICS, LTD. | MN | 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 12004 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12004 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. 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 12004 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 |
|---|---|---|
| 12002-CPT | Low | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.6 Cm To 7.5 Cm |
| 12004-CPT | Low | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 7.6 Cm To 12.5 Cm |
| 12005-CPT | Moderate | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 12.6 Cm To 20.0 Cm |
| 12006-CPT | Moderate | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 20.1 Cm To 30.0 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12004 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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