CPT 15260 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 79 - Unrelated procedure - postop period • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 15260 by major payers:

$1,139.06

$1,256.71

$1,295.60

$1,625.09
| 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 15260 | ||||||
United | 15260 | $540.00 | 1851845986 - WEST SHORE PAIN AND SPINE INSTITUTE, LLC | 812668532 - (PA) WEST SHORE PAIN AND SPINE INSTITUTE LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1258.00 | 1386657047 - THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CENTER, LLC | 20594510 - (TX) THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CTR, LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $700.00 | 1952363368 - GOLDEN TRIANGLE SURGICENTER LP | 330529450 - (CA) GOLDEN TRIANGLE SURGICENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1073.00 | 1871513705 - SQUAW PEAK SURGICAL FACILITY INC | 860889294 - (AZ) SQUAW PEAK SURGICAL FACILITY INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $840.00 | 1013309459 - MELBOURNE SURGERY CENTER, LLC, MELBOURNE SURGERY CENTER | 582101921 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $457.00 | 1891772547 - NOVAMED SURGERY CENTER OF BATON ROUGE LLC, INTERVENTIONAL PAIN MANAGEMENT CENTER | 262609309 - (LA) NOVAMED SURGERY CENTER OF BATON ROUGE LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $496.00 | 1770645905 - SILVER SPRING MD ENDOSCOPY ASC LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND | 205988845 - (MD) SILVER SPRING MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1771.54 | 1720435118 - ELIZABETH TURLEY | 350593390 - DEACONESS HOSPITAL INC | KY | Family Medicine Physician (207Q00000X) |
United | 15260 | $450.00 | 1649407180 - PAIN MDS INC | 270279190 - (AZ) PAIN MDS INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1503.00 | 1295790327 - ENDOSCOPY OF PLANO, LP, GASTROINTESTINAL ENDOSCOPY CENTER OF PLANO | 201477775 - (TX) ENDOSCOPY OF PLANO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1771.54 | 1295713857 - ARTHUR BENTSEN | 350593390 - DEACONESS HOSPITAL INC | IN | Pulmonary Disease Physician (207RP1001X) |
United | 15260 | $443.00 | 1538113238 - ADVANCED LASER & SURGICENTER OF ARIZONA, PC | 721546625 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $430.00 | 1154440972 - SEBASTOPOL ASC, L.P. | 621560936 - (CA) SEBASTOPOL ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15260 | $1771.54 | 1346209798 - VERNON TAYLOR | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 15260 | $1039.00 | 1053366930 - ADVANCED SURGERY CENTER, LLC | 342045695 - (NE) ADVANCED SURGERY CENTER, LLC | NE | 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 15260 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15260 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 15260 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15260 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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