CPT 19301 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 19301 |
National average reimbursement for CPT 19301 by major payers:
$801.77
$809.81
$866.03
$1,061.98
| 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 19301 | ||||||
United | 19301 | $960.00 | 1770796757 - LAPEER COUNTY SURGERY CENTER LLC | 202918877 - (MI) LAPEER COUNTY SURGERY CENTER L | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $2595.00 | 1447320213 - FREEHOLD ENDOSCOPY ASSOCIATES, LLC, ENDOSCOPY CENTER OF MONMOUTH COUNTY | 841634126 - (NJ) FREEHOLD ENDOSCOPY ASSOCIATES | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $770.40 | 1184863631 - PRADEEP RAI | 841043351 - (CO) COLORADO VISITING NURSE ASSOCIATION | OH | Surgery Physician (208600000X) |
United | 19301 | $2235.58 | 1104047083 - ANKUSH GOSAIN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | VA | Pediatric Surgery Physician (2086S0120X) |
United | 19301 | $2238.18 | 1750763017 - RYAN JAHN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 19301 | $2238.18 | 1710424460 - FRANCES FENG | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | LA | Cytopathology Physician (207ZC0500X) |
United | 19301 | $4831.00 | 1548280209 - SHORT HILLS SURGERY CENTER, LLC, SHORT HILLS SURGERY CENTER | 721572665 - (NJ) SHORT HILLS SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $2848.61 | 1992961577 - WILLIAM ANDERSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Allergy/Immunology Physician (2080P0201X) |
United | 19301 | $1823.38 | 1649246042 - ANNE WAGNER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Trauma Surgery Physician (2086S0127X) |
United | 19301 | $2859.00 | 1740778554 - ORO VALLEY SURGICAL SUITES LLC | 823931790 - (AZ) ORO VALLEY SURGICAL SUITES, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $572.03 | 1659552040 - COLORADO OPHTHALMOLOGY ASSOCIATES PC | 840596940 - (CO) COLORADO OPHTHALMOLOGY ASSOCIATES PC | CO | Specialist (174400000X) |
United | 19301 | $1754.06 | 1023128873 - CHRISTIANE THIENELT | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Hematology & Oncology Physician (207RH0003X) |
United | 19301 | $900.00 | 1528080876 - FRY EYE SURGERY CENTER, LLC | 742823718 - (KS) FRY EYE SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $1100.58 | 1235257346 - LISA WHITTAKER | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Physician Assistant (363A00000X) |
United | 19301 | $953.39 | 1861503948 - FOUR CORNERS OB/GYN | 841451020 - (CO) FOUR CORNERS OB-GYN, LLP | CO | Specialist (174400000X) |
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 19301 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19301 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 19301 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 |
|---|---|---|
| 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) |
| 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 |
| 19301-CPT | Moderate | Mastectomy, Partial (E.G. Lumpectomy, Tylectomy, Quandrantectomy, Segmentectomy) |
| 19302-CPT | High | With Axillary Lymphadenectomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19301. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19301 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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