CPT 15854 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 15854 |
National average reimbursement for CPT 15854 by major payers:
$20.74
$22.26
$19.53
$38.60
| 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 15854 | ||||||
United | 15854 | $688.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $3146.00 | 1326046822 - SOUTH EMERSON SURGERY CENTER, LLC | 352087260 - (IN) SOUTH EMERSON SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $169.00 | 1053496240 - OAKLAND CA ENDOSCOPY ASC LP, EAST BAY ENDOSURGERY CENTER | 205645928 - (CA) OAKLAND CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $300.00 | 1750709358 - EASTSIDE MEDICAL GROUP, LLC | 451231126 - (WA) EASTSIDE MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $644.00 | 1417919879 - HUNTERDON ENDOSURGERY CENTER | 223597546 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $60.00 | 1548582463 - CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER, LLC, NONE | 271867311 - (VA) CAREPLEX ORTHOPAEDIC AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $120.00 | 1285340430 - CORRIDOR SURGERY CENTER | 832869527 - (IA) CORRIDOR SURGERY CENTER | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $500.00 | 1679108914 - PRECISION SC, LLC, PRECISIONCARE SURGERY CENTER | 832882696 - (NY) PRECISION SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $164.00 | 1780752352 - PREMIER SURGERY CENTER OF SANTA MARIA LLC | 203502741 - (CA) PREMIER SURGERY CENTER OF SANTA MARIA, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $125.00 | 1245288257 - SURGICAL CENTER OF GREENSBORO, LLC | 631251243 - (NC) SURGICAL CENTER OF GREENSBORO LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $109.00 | 1215429030 - MEDICAL AND DENTAL CENTER OF NEVADA LLC | 825250965 - (NV) MEDICAL AND DENTAL CENTER OF NEVADA LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $566.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $215.00 | 1437501145 - NORTH CARE ASC, LLC | 810851059 - (CO) NORTH CARE ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $566.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15854 | $79.00 | 1790269462 - BARBOUR ORTHOPAEDICS SURGERY CENTER, LLC | 822423698 - (GA) BARBOUR ORTHOPAEDICS SURGERY CENTER LLC | GA | 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 15854 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15854 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 15854 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 |
|---|---|---|
| 15851-CPT | Low | Removal Of Sutures Or Staples Requiring Anesthesia (Ie General Anesthesia Moderate Sedation) (Desc Rvsd 1/1/23) |
| 15852-CPT | Low | Dress Change Not Burn Under Anes |
| 15853-CPT | Low | Removal Of Sutures Or Staples Not Requiring Anesthesia (List Separately In Addition To E/M Code) |
| 15854-CPT | Low | Removal Of Sutures And Staples Not Requiring Anesthesia (List Separately In Addition To E/M Code) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15854. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15854 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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