CPT 15116 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 | Low |
| Medicare Fee Schedule | View Medicare rates for 15116 |
National average reimbursement for CPT 15116 by major payers:
$194.59
$213.50
$206.50
$263.43
| 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 15116 | ||||||
United | 15116 | $1444.00 | 1578741849 - SCOTT AND WHITE HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TAYLOR | 741595711 - (TX) SCOTT & WHITE HOSPITAL-TAYLOR | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $487.00 | 1558612762 - QUEENS BOULEVARD ASC LLC | 274614930 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $471.00 | 1245482280 - NORTHWEST AMBULATORY SURGERY CENTER LLC, NORTHWEST AMBULATORY SURGERY CENTER | 263548852 - (OR) NORTHWEST AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $914.00 | 1760035158 - LEIGH ORTHOPEDIC SURGERY CENTER, LLC | 832402528 - (VA) LEIGH ORTHOPEDIC SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $959.00 | 1942722798 - DREXEL TOWN SQUARE SURGERY CENTER, LLC, DREXEL TOWN SQUARE SURGERY CENTER | 814904300 - (WI) DREXEL TOWN SQUARE SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $150.00 | 1336649714 - HEALTHQARE SERVICES ASC LLC, HEALTHQARE SERVICES ASC LLC | 815460194 - (VA) HEALTHQARE SERVICES ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $681.00 | 1467415513 - LAS VEGAS SURGICARE LTD | 880244070 - (NV) LAS VEGAS SURGICARE LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $1344.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $320.00 | 1124068549 - CROWN VALLEY SURGERY CENTER | 454125214 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $150.00 | 1265404669 - NORTH RIVER SURGERY CENTER, LLC | 710799771 - (AR) NORTH RIVER SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $311.00 | 1336272657 - ARIZONA DIGESTIVE CENTER, P.C. | 201544723 - (AZ) ARIZONA DIGESTIVE CENTER PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $381.00 | 1922255413 - TWIN CITIES AMBULATORY SURGERY CENTER LP, TWIN CITIES SURGERY CENTER | 260839397 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $385.00 | 1992941462 - NORTHWEST ENDOSCOPY CENTER, LLC, NORTH WEST ENDOSCOPY CENTER | 364644974 - (GA) NORTHWEST ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $51.00 | 1114951365 - DOCTORS SURGERY CENTER, PA | 710718664 - (AR) DOCTORS SURGERY CENTER PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15116 | $132.00 | 1336143148 - MARIN OPHTHALMIC SURGERY CENTER | 680297790 | CA | 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 15116 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15116 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 15116 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 |
|---|---|---|
| 13132-CPT | Moderate | Rep Complex Face Hands 2.5-7.5cm |
| 13152-CPT | Moderate | Compls Rpr Eye Nose Ear Lip 2.6-7.5 |
| 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 |
| 15116-CPT | Low | Epiderman Autograft Face Scalp Eyelids Mouth Neck Ears Orbits Genitalia Hands Feet And/Or Multiple Digits; First 100 Sq Cm Or Less Or One Percent Of Body Area Of Infants And Children; Each Additional 100 Sq Cm Or Each Additional One Percent Of Body Area Of Infants Andchildren Or Part Thereof (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 15116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15116 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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