CPT 16035 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 | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 16035 |
National average reimbursement for CPT 16035 by major payers:
$249.46
$262.90
$253.81
$327.35
| 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 16035 | ||||||
United | 16035 | $209.00 | 1659356392 - LASER & CATARACT CENTER OF SHREVEPORT LLC, EYE SURGERY CENTER | 721382751 - (LA) LASER CATARACT CENTER OF SHREVEPORT LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $78.00 | 1255390670 - CARROLL COUNTY EYE SURGERY CENTER, LLC | 50576667 - (MD) CARROLL COUNTY EYE SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $1708.00 | 1447489695 - AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, L.L.C., VIRTUA CENTER FOR SURGERY | 208643005 - (NJ) AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $529.00 | 1750303855 - MEADOWS SURGERY CENTER, LLC, MEADOWS SURGERY CENTER | 200181381 - (NJ) MEADOWS SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $270.00 | 1043271604 - NORTH FULLERTON SURGERY CENTER, LLC | 223849885 - (NJ) NORTH FULLERTON SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $84.00 | 1598921819 - THE PHYSICIANS' NORTH ATLANTA SURGERY CENTER LLC | 204676137 - (GA) THE PHYSICIANS NORTH ATLANTA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $201.00 | 1750036174 - GLACIER SURGICAL INC. | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $1343.00 | 1962435990 - NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC, CENTER FOR BONE AND JOINT SURGERY | 201026094 - (NJ) NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $653.00 | 1134182546 - JACKSONVILLE SURGERY CENTER, LTD | 621600402 - (FL) JACKSONVILLE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $258.00 | 1437871373 - NORTHEAST INDIANA AMBULATORY SURGERY CENTER LLC | 830979985 - (IN) NORTHEAST INDIANA AMBULATORY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $135.00 | 1407334881 - BEACON ORTHOPAEDIC SURGERY CENTER, BEACON AMBULATORY SURGERY CENTER | 311800570 - (OH) BEACON ORTHOPAEDICS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $200.00 | 1962869826 - ENDOTECH, LLC | 472926864 - (AZ) ENDOTECH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $136.00 | 1285678979 - BAY SURGERY CENTERS LLC, CLEARWAY SURGERY CENTER OF ANNAPOLIS | 204934078 - (MD) BAY SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $531.00 | 1205949245 - MEMORIAL SURGERY CENTER, LLC | 201167151 - (OK) MEMORIAL SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $168.00 | 1922248517 - AIDEN CENTER FOR DAY SURGERY LLC | 800161881 - (IL) AIDEN CENTER FOR DAY SURGERY LLC | IL | 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 16035 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 16035 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 16035 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 |
|---|---|---|
| 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) |
| 16035-CPT | Moderate | Escharotomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 16035. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 16035 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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