CPT 19294 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19294 |
National average reimbursement for CPT 19294 by major payers:
$203.91
$220.87
$209.26
$278.79
| 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 19294 | ||||||
United | 19294 | $118.00 | 1629078043 - NOVAMED EYE SURGERY CENTER OF OVERLAND PARK, LLC, OVERLAND PARK SURGERY CENTER | 364130546 - (KS) NOVAMED EYE SURGERY CENTER OF OVERLAND PARK LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $121.00 | 1225378276 - WHITE OAK SURGERY CENTER | 273885555 - (GA) WHITE OAK SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $150.00 | 1104457274 - TEXAS MIDWEST ENDOSCOPY CENTER, LLC | 842574842 - (TX) TEXAS MIDWEST ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $633.00 | 1255373601 - CHESTERFIELD AMBULATORY SURGERY CENTER LP, CHESTERFIELD SURGERY CENTER | 203834076 - (MO) CHESTERFIELD AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $555.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $183.00 | 1477617751 - COLUMBIA SURGICAL SPECIALISTS, PS, COLUMBIA SURGERY CENTER | 910867604 - (WA) COLUMBIA SURGICAL SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $50.00 | 1578567954 - E. RONALD SALVITTI, M.D., INC., SOUTHWESTERN PA EYE SURGERY CENTER | 251787703 - (PA) E. RONALD SALVITTI, M.D., INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $566.00 | 1831489335 - HAGERSTOWN SURGERY CENTER,LLC | 274935096 - (MD) HAGERSTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $555.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $1306.00 | 1922237213 - ENDOSCOPY CENTER OF TOMS RIVER, LLC | 300568338 - (NJ) ENDOSCOPY CENTER OF TOMS RIVER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $126.00 | 1992709851 - NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC | 50540721 - (IL) NOVAMED SURGERY CENTER OF CHICAGONORTHSHORE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $1675.00 | 1649500950 - NATIONAL AMBULATORY SURGERY CENTER, LLC | 271343081 - (CA) NATIONAL AMBULATORY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $840.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $107.00 | 1558451583 - LIPPY SURGERY CENTER LLC | 205293709 - (OH) LIPPY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $361.00 | 1295131001 - OPTUMCARE COLORADO ASC, LLC, COLORADO SPRINGS HEALTH PARTNERS ASC, LLC | 352597463 | CO | 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 19294 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19294 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 19294 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 |
| 19125-CPT | Moderate | Excision Breast Lesion; Single Lesion |
| 19294-CPT | Moderate | Preparation Of Tumor Cavity With Placement Of A Radiation Therapy Applicator For Intraoperative Radiation Therapy (Iort) Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19294. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19294 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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