CPT 19125 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 19125 by major payers:
$714.65
$692.90
$740.07
$904.77
| 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 19125 | ||||||
United | 19125 | $1884.72 | 1316237381 - MELISSA NEW | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 19125 | $574.15 | 1225568892 - EDEN NOHRA | 800033443 - (NY) UNIVERSITY AT BUFFALO SURGEONS INC | NY | Trauma Surgery Physician (2086S0127X) |
United | 19125 | $574.95 | 1851718902 - HUSAYN LADHANI | 481169103 - SALINA REGIONAL HEALTH CENTER INC | CO | Trauma Surgery Physician (2086S0127X) |
United | 19125 | $870.53 | 1710114731 - DAVID HAMILTON | 841276956 - (CO) COLORADO SPRINGS ORTHOPAEDIC GROUP | CO | Surgery Physician (208600000X) |
United | 19125 | $1080.81 | 1982864856 - ALAN SEARS | 900733285 | CO | Surgery Physician (208600000X) |
United | 19125 | $1946.25 | 1588778351 - KIMBERLY THOMAS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Physician Assistant (363A00000X) |
United | 19125 | $1506.02 | 1831540772 - ANDREW KOO | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | MI | Obstetrics & Gynecology Physician (207V00000X) |
United | 19125 | $1477.06 | 1275928350 - ARASH ESLAMI | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Cytopathology Physician (207ZC0500X) |
United | 19125 | $1477.06 | 1174864318 - CECELIA KOETTING | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Optometrist (152W00000X) |
United | 19125 | $4719.00 | 1881628725 - CATHOLIC HEALTH INITIATIVES COLORADO, <UNAVAIL> | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | Specialist (174400000X) |
United | 19125 | $510.86 | 1932889326 - CHERISE FRAZIER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Clinical Social Worker (1041C0700X) |
United | 19125 | $967.25 | 1538441563 - CARA REITZ | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | TX | Surgery Physician (208600000X) |
United | 19125 | $926.78 | 1013968403 - RUSSELL ALLEN | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Anesthesiology Physician (207L00000X) |
United | 19125 | $926.78 | 1376887158 - TARA SALAMAT | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Physician Assistant (363A00000X) |
United | 19125 | $1847.78 | 1114556297 - ABIGAIL DOHERTY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Adult Health Nurse Practitioner (363LA2200X) |
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 19125 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19125 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 19125 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 |
| 19101-CPT | Moderate | Biopsy Of Breast Incisional |
| 19120-CPT | Moderate | Excision Of Cyst, Fibroadenoma, Or Other Benign Or Malignant Tumor, Aberrant Breast Tissue, Duct Lesion, Nipple Or Areolar Lesion (Except 19300), Open, Male Or Female, 1 Or More Lesions |
| 19125-CPT | Moderate | Excision Breast Lesion; Single Lesion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19125 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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