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 |
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 | $574.00 | 1053764779 - SURGCENTER OF ST. LUCIE, LLC | 475425011 - (FL) SURGCENTER OF ST. LUCIE, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $662.00 | 1962626523 - CALLOWAY CREEK SURGERY CENTER LP | 141948102 - (TX) CALLOWAY CREEK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $200.00 | 1376269324 - THE SURGEON'S POINT SURGERY CENTER, LLC, THE SURGEON'S POINT AT CEDAR PARK | 301282509 - (TX) THE SURGEONS POINT SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $992.00 | 1861766016 - HAYS SURGERY CENTER, LLC | 274579547 - (TX) HAYS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $566.00 | 1215492061 - ADVANCED SPINE CENTER OF WISCONSIN, LLC | 832438541 - (WI) ADVANCED SPINE CENTER OF WISCONSIN | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $141.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $646.00 | 1053803692 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $370.00 | 1043254162 - FVOSA SURGICAL PARTNERS, LLC, ORTHOPEDIC & SPORTS SURGERY CENTER | 202394424 - (WI) FVOSA SURGICAL PARTNERS, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $79.00 | 1710985445 - HERSHEY ENDOSCOPY CENTER, LLC | 562336622 - (PA) HERSHEY ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $125.00 | 1467499293 - ST CLOUD MN OPHTHALMOLOGY ASC LLC, ST. CLOUD CENTER FOR OPHTHALMIC SURGERY | 203853072 - (MN) ST CLOUD MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $566.00 | 1184687386 - DIGESTIVECARE, LLC, DIGESTIVECARE ENDOSCOPY UNIT | 311108485 - (OH) DIGESTIVE CARE, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $117.00 | 1679585772 - MEDICAL CENTER ENDOSCOPY, LLC, MEDICAL CENTER ENDOSCOPY | 760550704 - (TX) MEDICAL CENTER ENDOSCOPY, LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $95.00 | 1063445542 - TOTAL PAIN CARE LLC | 202484443 - (MS) TOTAL PAIN CARE, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19294 | $1708.00 | 1730410697 - SURGICAL SPECIALISTS AT PRINCETON LLC | 270749140 - (NJ) SURGICAL SPECIALISTS AT PRINCE | NJ | 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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