CPT 19296 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 19296 by major payers:
$4,019.16
$5,177.32
$4,984.91
$6,507.49
| 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 19296 | ||||||
United | 19296 | $3986.00 | 1265404115 - WILLMAR MEDICAL SERVICES, LLP | 823166379 - (MN) CARRIS HEALTH LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $3800.00 | 1396796249 - TAMPA BAY SURGERY CENTER ASSOCIATES, LTD. | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $6087.00 | 1912265653 - BRASELTON ENDOSCOPY CENTER, LLC | 453369410 - (GA) BRASELTON ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $5455.00 | 1760568273 - WALLA WALLA CLINIC, INC., WALLA WALLA CLINIC AMBULATORY SURGERY CENTER | 910862542 - WALLA WALLA CLINIC, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $4064.00 | 1497011308 - BENJAMIN CHUNG MD INC, RIVERWALK SURGERY CENTER | 454738248 - (CA) BENJAMIN CHUNG MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $390.00 | 1639352347 - THE KISSIMMEE FL ENDOSCOPY ASC LLC, KISSIMMEE ENDOSCOPY CENTER | 208927561 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $6588.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $1721.00 | 1558416255 - VIRGIL V. WILLARD, II MD PA, CENTER FOR IMAGE DISCOVERY PA | 300399108 - (NC) VIRGIL V WILLARD II MD PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $9542.00 | 1538245717 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $2258.00 | 1285608075 - PUEBLO CO OPHTHALMOLOGY ASC LLC, ROCKY MOUNTAIN LASER & SURGERY CENTER | 200121336 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $3500.00 | 1871169136 - WICHITA FALLS SPECIALTY ASC LLC, MOMENTUM SPECIALTY SURGERY CENTER | 842950505 - (TX) WICHITA FALLS SPECIALTY ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $5846.00 | 1750970869 - BSC CHANDLER LLC | 853443457 - (AZ) BSC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $5255.00 | 1306833009 - SOUTH BROWARD ENDOSCOPY L L C | 113685842 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $3704.00 | 1952368482 - SAN DIEGO ENDOSCOPY CENTER | 770322251 - (CA) SAN DIEGO ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19296 | $3725.00 | 1770072803 - PACIFIC VASCUCARE SURGERY CENTER | 823288521 - (CA) PACIFIC VASCUCARE SURGERY CENTER | 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 19296 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19296 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 19296 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 |
|---|---|---|
| 19296-CPT | High | Placement Of Radiotherapy Afterloading Expandable Catheter (Single Or Multichannel) Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy, Includes Imaging Guidance; On Date Separate From Partial Mastectomy |
| 19297-CPT | Low | Placement Of Radiotherapy Afterloading Expandable Catheter (Single Or Multichannel) Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy, Includes Imaging Guidance; Concurrent With Partial Mastectomy (List Separately In Addition To |
| 19298-CPT | High | Placement Of Radiotherapy Afterloading Brachy- Therapy Catheter (Multiple Tube And Button Type) Into The Breast For Interstitial Radioelement Application Following (At The Time Of Or Subse- Quent To) Partial Mastectomy Includes Imaging Guidance |
| 19357-CPT | High | Tissue Expander Placement In Breast Reconstruction Including Subsequent Expansion(S) (Desc Rvsd 1/1/21) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19296 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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