CPT 15630 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 58 - Staged or Related Procedure or Service During Postoperative Period by Same Physician • GC - Service has been performed in part by a resident under the direction of a teaching physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 15630 by major payers:
$562.89
$580.02
$609.76
$744.03
| 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 15630 | ||||||
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CPT 15630 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15630 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 15630 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 |
|---|---|---|
| 15570 | High | Form Direct Tube Pedicle W/Wo Trnsfer Tr |
| 15574 | High | Formation Of Direct Or Tubed Pedicle, With Or Without Transfer; Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands Or Feet |
| 15600 | Moderate | Intermediate ''delay'' Of Any Flap, Primary ''delay'' Of Small Flap, Or Sectioning Pedicle Of Tubed Or Direct Flap |
| 15630 | Moderate | Intermediate ''delay'' Of Any Flap, Primary ''delay'' Of Small Flap, Or Sectioning Pedicle Of Tubed Or Direct Flap |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15630. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15630 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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