CPT 19101 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19101 |
National average reimbursement for CPT 19101 by major payers:
$399.61
$425.14
$437.77
$535.04
| 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 19101 | ||||||
United | 19101 | $267.32 | 1821721739 - CAROLYN COLE | 350593390 - DEACONESS HOSPITAL INC | IN | Medical Physician Assistant (363AM0700X) |
United | 19101 | $1550.00 | 1144827114 - GULFSTREAM SURGICAL FORT WORTH LLC | 851495125 - (TX) GULFSTREAM SURGICAL FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $267.32 | 1336165521 - SUMMER SWINNEY | 350593390 - DEACONESS HOSPITAL INC | MS | Certified Registered Nurse Anesthetist (367500000X) |
United | 19101 | $1816.00 | 1497165179 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF PHOENIX | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $1251.00 | 1538117841 - SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC, SHELBY AMBULATORY SURGERY AT THE PHYSICIANS CENTER | 203150946 - (AL) SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $544.00 | 1497831523 - BOSTON IVF, INC., THE SURGERY CENTER OF WALTHAM | 42921956 - (MA) BOSTON IVF, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $3273.00 | 1912993833 - SURGICENTER OF KANSAS CITY, LLC | 431828920 - (MO) SURGICENTER OF KANSAS CITY, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $1776.00 | 1427015999 - WEST SHORE SURGERY, LTD, WEST SHORE SURGERY CENTER, LTD | 251821415 - (PA) WEST SHORE SURGERY CENTER, LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $778.00 | 1548399561 - DES PERES EYE SURGERY CENTER, LLC, ST LOUIS EYE SURGERY AND LASER CENTER | 208491493 - (MO) DES PERES EYE SURGERY CENTER, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $2353.00 | 1952749491 - HAYMARKET SURGERY CENTER, LLC | 462874962 - (VA) HAYMARKET SURGERY CENTER | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $1418.00 | 1982211728 - FT SCOTT SURGERY CENTER LLC | 853127325 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $2659.00 | 1386190957 - HOLLY SPRINGS SURGERY CENTER, LLC | 473460976 - (NC) HOLLY SPRINGS SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $267.32 | 1275504706 - MELISSA EISENHAUER | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 19101 | $591.00 | 1851490445 - GOLDEN STATE EYE CENTER | 770128181 - (CA) GOLDEN STATE EYE CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19101 | $591.00 | 1821112145 - SCRIPPS ENCINITAS SURGERY CENTER, LLC | 205942958 - (CA) SCRIPPS ENCINITAS SURGERY CENTER LLC | CA | 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 19101 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19101 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 19101 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 |
|---|---|---|
| 19083-CPT | Moderate | Biopsy, Breast, With Placement Of Breast Localization Device(S) (Eg, Clip, Metallic Pellet), When Performed, And Imaging Of The Biopsy Specimen, When Performed, Percutaneous; First Lesion, Including Ultrasound Guidance |
| 19085-CPT | Moderate | Biopsy, Breast, With Placement Of Breast Localization Device(S) (Eg, Clip, Metallic Pellet), When Performed, And Imaging Of The Biopsy Specimen, When Performed, Percutaneous; First Lesion, Including Magnetic Resonance Guidance |
| 19100-CPT | Low | Biopsy Breast Needle |
| 19101-CPT | Moderate | Biopsy Of Breast Incisional |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19101. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19101 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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