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 |
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 | $1446.00 | 1992037352 - BAYLOR SURGICARE AT MANSFIELD, LLC, BAYLOR SCOTT & WHITE SURGICARE - MANSFIELD | 271835675 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $125.00 | 1154718070 - FERTILITY LAB SCIENCES OF MINNEAPOLIS, LLC | 465432360 - (MN) FERTILITY LAB SCIENCES OF MINN | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $324.00 | 1437116274 - SILVER SPRINGS SURGERY CENTER LLC | 431804124 - (MO) SILVER SPRINGS SURGERY CENTER LLC | MO | 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 | $319.00 | 1194716191 - AMBULATORY SURGICAL CENTER OF UNION COUNTY, LLC | 223740023 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $200.00 | 1962869826 - ENDOTECH, LLC | 472926864 - (AZ) ENDOTECH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $179.00 | 1073818654 - ROYAL OAK SURGICAL CENTER, LLC, ROYAL OAK SURGICAL CENTER PLLC | 320323562 - (MI) ROYAL OAK SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $574.00 | 1942507488 - GA ENDOSCOPY CENTER, LLC | 273115800 - (GA) GA ENDOSCOPY CENTER LLC | GA | 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 | $569.00 | 1962431197 - SHAWNEE MISSION SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER SHAWNEE MISSION | 481243914 - (KS) SHAWNEE MISSION SURGERY CENTER LLC | KS | 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 | $1708.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $326.00 | 1538231956 - COASTAL MEDICAL CENTER LLC | 650956639 - (FL) COASTAL MEDICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $357.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 16035 | $373.00 | 1255332805 - PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER LLC, DIGESTIVE DISEASE ENDOSCOPY CENTER | 50540368 - (IL) PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER, 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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