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 |
| Medicare Fee Schedule | View Medicare rates for 19125 |
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 | $884.50 | 1477967404 - MARK EDGCOMB | 452298151 - (TX) SPECIALTY ASSOCIATES OF WEST HOUSTON PLLC | IL | Surgery Physician (208600000X) |
United | 19125 | $2351.70 | 1447464110 - MELISSA STILLBERGER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Genetic Counselor (M.S.) (170300000X) |
United | 19125 | $926.78 | 1477966505 - LINDSAY JOBE | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | NM | Surgery Physician (208600000X) |
United | 19125 | $599.82 | 1750573010 - PLATTE VALLEY INTERNAL MEDICINE & PULMONARY LLC | 841348348 - (CO) PLATTE VALLEY INTERNAL MEDICINE AND PULMONARY ASSOCIATES, LLC | CO | Specialist (174400000X) |
United | 19125 | $926.78 | 1740271063 - RICHARD MILCHAK | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Pulmonary Disease Physician (207RP1001X) |
United | 19125 | $2206.00 | 1790104248 - METRO SURGERY CENTER, LLC, METRO SURGERY CENTER, LP | 810587498 - (AZ) METRO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19125 | $1021.73 | 1053714584 - PRO HEALTH ONE INC | 471007692 - PRO HEALTH ONE | CO | Surgery Physician (208600000X) |
United | 19125 | $910.28 | 1467484147 - MICHAEL MURRAY | 813228396 - (CO) COLORADO SURGICAL AFFILIATES, LLC | CO | Specialist (174400000X) |
United | 19125 | $1506.02 | 1538311014 - BRIAN BURNE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Occupational Therapist (225X00000X) |
United | 19125 | $926.78 | 1699155879 - KAELI YAMASHIRO | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Surgery Physician (208600000X) |
United | 19125 | $856.63 | 1962454900 - DAVID CIESLA | 30219309 - UNIVERSITY OF VERMONT MEDICAL CENTER INC | VT | Surgery Physician (208600000X) |
United | 19125 | $528.00 | 1336272657 - ARIZONA DIGESTIVE CENTER, P.C. | 201544723 - (AZ) ARIZONA DIGESTIVE CENTER PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19125 | $781.00 | 1376603241 - ROSS LEIBOVITZ | 841174630 | CO | Surgery Physician (208600000X) |
United | 19125 | $1882.53 | 1598889099 - JOYCE FU | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 19125 | $926.78 | 1316266703 - RACHAEL NEMCIC | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Surgery Physician (208600000X) |
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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