CPT 15935 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • GC - Service performed by resident under supervision • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 15935 |
National average reimbursement for CPT 15935 by major payers:
$1,354.30
$1,449.23
$1,421.58
$1,851.79
| 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 15935 | ||||||
United | 15935 | $2617.00 | 1619933835 - MISSISSIPPI MEDICAL PLAZA, LC, MISSISSIPPI VALLEY SURGERY CENTER | 421429641 - (IA) MISSISSIPPI MEDICAL PLAZA, L.C. | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $3500.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $4600.00 | 1639146541 - CENTENNIAL ASC, LLC, BAYLOR SURGICARE AT CENTENNIAL | 352199232 - (TX) CENTENNIAL ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $3570.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1278.00 | 1326107509 - OMAHA AMBULATORY SURGERY CENTER LLC | 205880863 | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1707.00 | 1477178879 - SURGCENTER OF FAYETTEVILLE, LLC | 844038708 - (AR) SURGCENTER OF FAYETTEVILLE LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $2549.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $3508.00 | 1275886319 - SURGERY CENTER OF BAY AREA HOUSTON, LLC | 320383244 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $2183.00 | 1144652330 - UNIVERSITY SURGERY CENTER LLC, MALLARD CREEK SURGERY CENTER | 462574454 - (NC) UNIVERSITY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $3500.00 | 1770929044 - SURGCENTER OF PALM BEACH GARDENS, SURGCENTER OF PALM BEACH GARDENS, LLC | 462315994 - (FL) SURGCENTER OF PALM BEACH GARDENS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1484.00 | 1407829773 - LA JOLLA ENDOSCOPY CENTER LP, LA JOLLA ENDOSCOPY CENTER | 621806062 - (CA) LA JOLLA ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1573.00 | 1235240813 - NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | 200145190 - (MS) NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1568.00 | 1437320017 - OREGON EYE SURGERY CENTER, INC. | 930973443 - (OR) OREGON EYE SURGERY CENTER INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $3570.00 | 1295176139 - LOWCOUNTRY AMBULATORY CENTER, LLC | 274109893 - (SC) LOWCOUNTRY AMBULATORY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 15935 | $1900.00 | 1811125149 - KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | 262437385 - (TN) KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | TN | 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 15935 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 15935 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 15935 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 |
|---|---|---|
| 15934-CPT | High | Excision, Sacral Pressure Ulcer, With Local Or Regional Skin Flap Closure (Eg, Advancement, Rotation, Rhomboid, Bipe |
| 15935-CPT | High | Excision, Sacral Pressure Ulcer, With Local Or Regional Skin Flap Closure (Eg, Advancement, Rotation, Rhomboid, Bipe |
| 15936-CPT | High | Exc Sacral Ulcer W/Muscle Flap |
| 15937-CPT | High | Exc Decub Ulc Sacral Oth Flap+Ost |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 15935. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 15935 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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