CPT 15004 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 15004 by major payers:
$439.75
$508.53
$526.02
$642.62
| 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 15004 | ||||||
United | 15004 | $232.00 | 1639498454 - NEW VISTA HEALTH, LLC, PINEY POINT SURGERY CENTER | 272416864 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $1051.00 | 1003807835 - LAKEVIEW SURGERY CENTER LC | 421516120 - (IA) LAKEVIEW SURGERY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $497.00 | 1366864514 - GREAT SOUTH BAY ENDOSCOPY CENTER, LLC | 463055867 - (NY) GREAT SOUTH BAY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $274.00 | 1720566433 - PAVILION SURGICENTER, LLC, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $150.00 | 1528604675 - SURGERY CENTER OF NORTH TEXAS, PLLC | 831353164 - (TX) SURGERY CENTER OF NORTH TEXAS, PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $531.00 | 1831525112 - LONGLEAF SURGERY CENTER, LLC | 462421622 - (FL) LONGLEAF SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $506.00 | 1760486369 - MOUNTAIN EMPIRE SURGERY CENTER LP | 621772667 - (TN) MOUNTAIN EMPIRE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $122.00 | 1609103399 - TOURNEY PLAZA SURGICAL CENTER | 262034187 - (CA) TOURNEY PLAZA SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $250.00 | 1194341768 - WELLINGTON SPECIALTY SURGERY CENTER, LLC | 844962361 - (OH) WELLINGTON SPECIALTY SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $317.00 | 1417994831 - CATALINA SURGERY CENTER, LLC | 201680197 - (AZ) CATALINA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $188.00 | 1689326670 - PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC, PRISMA HEALTH ORTHOPEDIC SURGERY CENTER | 873101776 - (SC) PRISMA HEALTH AMBULATORY SURGERY CENTERSMIDLANDS LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $150.00 | 1679595680 - SURGERY CENTER OF LEBANON, LP, PHYSICIANS SURGICAL CENTER | 721588584 - (PA) SURGERY CENTER OF LEBANON LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $74.00 | 1649911470 - ST. PETERSBURG OUTPATIENT SURGERY CENTER, LLC | 842007777 - (FL) ST PETERSBURG OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $490.00 | 1386721249 - ALLIED PHYSICIANS SURGERY CENTER, LLC | 352057452 - (IN) ALLIED PHYSICIANS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $183.00 | 1245566744 - CHESTERFIELD ASC, LLC | 811166184 | MO | 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 15004 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15004 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 15004 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 |
|---|---|---|
| 13131-CPT | Moderate | Complx Rpr Face Hnd Ft 1.1-2.5 Cm |
| 13132-CPT | Moderate | Rep Complex Face Hands 2.5-7.5cm |
| 15004-CPT | Moderate | Surgical Preparation Or Creation Of Recipient Siteby Excision Of Opern Wounds Burn Eschar Or Scar (Including Subcutaneous Tissues) Or Incisional Release Of Scar Contracture Face Scalp Eyelids Mouth Neck Ears Orbits Genitalia Hands Feet And/Or Multiple Digits; First 100 Sq Cm Or 1% Of Body Area Of Infants And Children |
| 15005-CPT | Low | Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Wounds, Burn Eschar, Or Scar (Including Subcutaneous Tissues), Or Incisional Release Of Scar Contracture, Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet And/Or Multiple |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15004 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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