CPT 12034 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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 12034 |
National average reimbursement for CPT 12034 by major payers:
$369.68
$394.56
$431.05
$534.48
| 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 12034 | ||||||
United | 12034 | $300.00 | 1699745067 - NIAGARA HEALTH CENTER, INC | 391847009 - (WI) NIAGARA HEALTH CENTER | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $125.00 | 1922729847 - PARDEE AMBULATORY SURGERY CENTER LLC, THE SURGERY CENTER AT MILLS RIVER | 853190133 - (NC) PARDEE AMBULATORY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $296.00 | 1871174706 - AMBULATORY CARDIOVASCULAR CENTER OF MISSISSIPPI | 861979907 - (MS) AMBULATORY CARDIOVASCULAR CENTER OF MISSISSIPPI | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $120.00 | 1336605351 - KURESMART PAIN MANAGEMENT SURGERY CENTER, CLEARWAY SURGERY CENTER OF DUNDALK | 832407319 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $566.00 | 1336142413 - TEXAN AMBULATORY SURGERY CENTER, LP | 331058382 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $230.00 | 1639605595 - QUEEN CREEK SURGICAL CENTER, LLC | 821292127 - (AZ) QUEEN CREEK SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $125.00 | 1194960732 - ISURGERY, LLC | 300514883 - (SD) ISURGERY LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $531.00 | 1972092146 - SURGERY CENTRE OF SW FLORIDA LLC, FORT MYERS SURGERY CENTER | 10735856 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $1016.00 | 1700341468 - PORT WARWICK SURGERY CENTER, LLC | 832749039 - (VA) PORT WARWICK SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $163.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $143.00 | 1124283510 - WILLS EYE SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $290.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $90.00 | 1295772101 - CAPE CORAL AMBULATORY SURGERY CENTER, LLC, CAPE CORAL SURGERY CENTER | 202001489 - (FL) CAPE CORAL AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $53.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12034 | $254.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | OH | 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 12034 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12034 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 12034 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 |
|---|---|---|
| 12032-CPT | Moderate | Int Rpr Sclp Trnk Extrm 2.6-7.5 Cm |
| 12034-CPT | Moderate | Rep Intermed Scalp Etc 7.5-12.5cm |
| 12035-CPT | Moderate | Repair Intermediate Wounds Of Scalp Axillae K Atrunk And/Or Extremities (Excluding Hands And Feet) 12.6 Cm To 20.0 Cm) |
| 12036-CPT | Moderate | Rep Intermed Scalp Etc 20.0-30cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12034. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12034 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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