CPT 16000 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 | • 23 - Emergency Room • 20 - Urgent Care Facility |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AG - Primary physician |
| Complexity Level | Low |
National average reimbursement for CPT 16000 by major payers:
$85.68
$91.56
$93.50
$123.12
| 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 16000 | ||||||
United | 16000 | $240.00 | 1346213634 - SARASOTA ENDOSCOPY ASC LLC, BAYVIEW ENDOSCOPY CENTER | 621806248 - (FL) THE SARASOTA ENDOSCOPY ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $388.00 | 1578515367 - BLACK CANYON SURGICAL CENTER, LLC | 510514274 - (CO) BLACK CANYON SURGICAL CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $601.00 | 1386161495 - MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC | 820985178 - (MD) MEDSTAR SURGERY CENTER AT BRAN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $135.00 | 1376542076 - FREDERICK SURGICAL CENTER, LLC | 521652443 - (MD) FREDERICK SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $190.00 | 1881184356 - BLACKBURN &WHITNEY MD PS, PLASTIC SURGERY BELLINGHAM | 912176854 - (WA) BLACKBURN & WHITNEY MD PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $950.00 | 1316970916 - SURGICAL SPECIALTY CENTER, LLC | 721418824 - (LA) SURGICAL SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $803.00 | 1730466483 - HOAG OUTPATIENT CENTERS, LLC, HOAG ENDOSCOPY CENTER | 453587572 - (CA) HOAG OUTPATIENT CENTERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $90.00 | 1124071550 - ANDERSEN EYE SURGERY CENTER, LLC | 205044851 - (MI) ANDERSEN EYE SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $325.00 | 1851407795 - NORTHERN ILLINOIS SURGERY CENTER LIMITED PATRNERSHIP, THE CENTER FOR SURGERY | 363776424 - (IL) NORTHERN ILLINOIS SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $155.00 | 1265401202 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S., THE ORTHOPAEDIC SURGERY CENTER | 911502837 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $79.00 | 1902213432 - COBBLESTONE SURGERY CENTER, INC. | 464241477 - (GA) COBBLESTONE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $601.00 | 1518634732 - MEDSTAR HEALTH ENDOSCOPY CENTER | 872341245 - (MD) MEDSTAR HEALTH ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $79.00 | 1881131621 - FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC, AZURA SURGERY CENTER RENALUS PENSACOLA | 814605951 - (FL) FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $1831.00 | 1396175246 - MEMORIAL HERMANN BAY AREA ENDOSCOPY CENTER, LLC, BAY AREA ENDOSCOPY | 364773048 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16000 | $541.00 | 1487059002 - RIVERWALK ASC, LLC, RIVERWALK ASC | 472075991 | FL | 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 16000 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 16000 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 16000 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 |
|---|---|---|
| 15958-CPT | High | Excision, Trochanteric Pressure Ulcer, In Preparation For Muscle Or Myocutaneous Flap Or Skin Graft Closure; With Ostectomy |
| 16000-CPT | Low | Init Treat 1st Degree Burn Local |
| 16020-CPT | Low | Dressings And/Or Debridement Of Partial-Thickness Burns, Initial Or Subsequent; Small (Less Than 5% Total Body Surface Area) |
| 16025-CPT | Low | Dressings And/Or Debridement Of Partial-Thickness Burns, Initial Or Subsequent; Medium (Eg, Whole Face Or Whole Extremity, Or 5% To 10% Total Body Surface Area) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 16000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 16000 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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