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See a sample rate comparisonCPT 15734 Fee Schedule
CPT 15734 is classified under Surgery, in the Surgical Procedures on the Integumentary System subgroup.
Reconstructive Skin Flap, Surgery To Create A Reconstructive Flap Out Of Muscle Tissue. The Tissue Contains Its Own Blood Supply (Artery And Vein) And Is Used To Reconstruct A Body Structure.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | 59Distinct Procedural Service ASPA/NP/CNS assistant at surgery |
| Hospital Outpatient Group (APC) | APC 5055 - Level 5 Skin Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600975Sign up to view all 7 |
| Medicare Fee Schedule | View Medicare rates for 15734 |
| Medicaid Fee Schedule | $1,097.635 median of the 8 states in the free previewView Medicaid rates for 15734 |
National average reimbursement for CPT 15734 by major payers:
$1,778.34
BCBS / Anthem
$1,953.51
UnitedHealthcare
$2,063.27
Aetna
$2,320.08
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 15734.
CPT 15734
5 of 25 sample ratesHigher to lower in this preview
Center For Endoscopy LLC
$4,339.00Published rateDeer Pointe Surgical Center, LLC, Poa Surgery Center
Deer Pointe Surgical Center, LLC
$2,117.00Published rateOrthopaedic Surgery Center Of Asheville, Lp, Outpatient Surgery Center Of Asheville
Orthopaedic Surgery Center Of Asheville Lp
$1,650.00Published rateDoctors Gi Partnership Ltd, Hf Surgery Center At Babcock
Doctors Gi Partnership Ltd
$1,313.00Published rateSt Marks Surgical Center LLC
$601.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 15734 vs. Other Surgical Procedures on the Integumentary System Codes
The table lists codes related to 15734. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 15730-CPT | Midface Flap (Ie Zygomaticofacial Flap) With Preservation Of Vascular Pedicle(S) (Reinstated Code) Old Desc: Preparation For Skin Graft; Eyelids Nose Ears Lips (Deleted 3/31/2003) |
| 15731-CPT | Create Skin Tube, Surgery To Create A Stem Stalk Or Tube (Pedicle) Out Of Skin Transplanted From Another Site On The Body To Support A Structure Being Reconstructed. The Pedicle Contains Blood Vessels That Are Attached At The Reconstruction Site. |
| 15733-CPT | Muscle Myocutaneous Or Fasci, Muscle Myocutaneous Or Fasciocutaneous Flap Head And Neck With Named Vascular Pedicle (Ie Buccinators Genioglossus Temporalis Masseter Sternocleidomastoid Levator Scapulae) Nterpretation And Report Tery Disease Data Preparation And Transmission A |
| 15734-CPT | Reconstructive Skin Flap, Surgery To Create A Reconstructive Flap Out Of Muscle Tissue. The Tissue Contains Its Own Blood Supply (Artery And Vein) And Is Used To Reconstruct A Body Structure. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15734. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15734 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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Frequently Asked Questions
What is a CPT code?
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare professionals to report medical, surgical, and diagnostic services to entities such as physicians, health insurance companies, and accreditation organizations. They are crucial for accurate billing and record-keeping in the healthcare system.
How can I find the cost of a medical procedure?
Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, geographic location, and specific healthcare provider. You can get estimates by contacting your insurance provider, the healthcare facility directly, or by using online transparency tools. For a precise understanding of fee schedules based on CPT code and specific location, we recommend using platforms like Payerprice.
What is a fee schedule?
A fee schedule is a comprehensive list of fees or reimbursement rates used by healthcare providers and insurance companies to determine the payment amount for specific medical services or procedures. It outlines the maximum allowed amount an insurer will pay for a particular service and can vary significantly between different payers, regions, and types of services.
Why do medical costs vary so much?
Medical costs vary widely due to a multitude of factors. These include the geographic location, the specific healthcare provider or facility, the patient's insurance coverage (or lack thereof), the complexity of the procedure, and differing negotiation power between providers and insurance companies. Additionally, the historical lack of price transparency in healthcare has contributed to this variation.
Where can I look up specific medical procedure prices based on CPT code and location?
To look up specific medical procedure prices based on a CPT code and your specific location, you can utilize specialized online tools. We recommend using Payerprice, which offers a fee schedule lookup tool. This platform allows users to search for prices by inputting a CPT code and their specific location, providing more tailored cost information for various medical services and procedures.
What APC is CPT 15734 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 15734 to APC 5055 (Level 5 Skin Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 15734 in an ambulatory surgery center?
CMS lists CPT 15734 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 15734?
Hospital price transparency files list CPT 15734 under these revenue codes: including 0360, 0975, 0960, 0989 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.