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 | Surgical Preparation or Incisional Release of Scar Contracture Surgical Preparation for Skin Replacement Surgery |
| 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 |
| Medicare Fee Schedule | View Medicare rates for 15004 |
National average reimbursement for CPT 15004 by major payers:
$439.75
$508.53
$526.02
$437.36
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 15004 | $839.00 | 1164561064 - HUNTERDON CENTER FOR SURGERY, LLC, SURGERY TODAY | 223401213 - (NJ) HUNTERDON CENTER FOR SURGERY, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $450.00 | 1972223394 - BRONSON AMBULATORY SURGERY CENTER, LLC, BRONSON ORTHOPEDIC SURGERY CENTER | 842884815 - (MI) BRONSON AMBULATORY SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $688.00 | 1902959190 - RIVA ROAD SURGICAL CENTER, LLC | 870774597 - (MD) RIVA ROAD SURGICAL CENTER LLC | MD | 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 | $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 | $1122.00 | 1205892197 - ALASKA SURGERY CENTER, LIMITED PARTNERSHIP | 930982396 - (AK) ALASKA SURGERY CENTER LIMITED PARTNERSHIP | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $83.00 | 1558416255 - VIRGIL V. WILLARD, II MD PA, CENTER FOR IMAGE DISCOVERY PA | 300399108 - (NC) VIRGIL V WILLARD II MD PA | NC | 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 | $566.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $175.00 | 1225414246 - LV SURGERY CENTER LLC | 473021380 - (NV) LV SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $566.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $65.00 | 1114906393 - PHYSICIANS SURGERY CENTER LLC | 200435814 - (AR) PHYSICIANS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $330.00 | 1104465012 - EVERGREEN EYE CENTER, PLLC | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $232.00 | 1639498454 - NEW VISTA HEALTH, LLC, PINEY POINT SURGERY CENTER | 272416864 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15004 | $475.55 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 610701663 - (KY) DERMATOLOGY ASSOCIATES OF KENTUCKY, P.S.C. | KY | 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 Preparation for Skin Replacement Surgery Codes
The CPT 15004 code is part of the Surgical Preparation or Incisional Release of Scar Contracture services used for Surgical Preparation for Skin Replacement Surgery. 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 | Repair Complex Forehead Che, Repair Complex Forehead Cheeks Chin Mouth Neckaxillae Genitalia Hands Andor Feet 1.1 Cm To 2.5 Cm Repair Complex Forehead Cheeks Chinmouth Neck |
| 13132-CPT | Moderate | Repair Complex Forehead Che, Repair Complex Forehead Cheeks Chin Mouth Neckaxillae Genitalia Hands Andor Feet 2.6 Cm To 7.5 Cm Repair Complex Forehead Cheeks Chinmouth Neck |
| 15004-CPT | Moderate | Wound Prep F N Hf G, 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 Digits First 100 Sq Cm Or 1 Of Body Area Of Infants And Children |
| 15005-CPT | Low | Wnd Prep F N Hf G Addl Cm, 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 Digits Each Additional 100 Sq Cm Or Part Thereof Or Each Additional 1 Of Body Area Of Infants And Children 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 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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