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 |
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 | $2527.00 | 1730571118 - MEDSTAR MEDICAL GROUP | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $2063.61 | 1982711503 - WAYNE YAKES | 481286437 - WAYNE F. YAKES, M.D. PROFESSIONAL LLC | CO | Specialist (174400000X) |
United | 19301 | $1402.47 | 1164749875 - DAVID NORTHERN | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | AL | Surgery Physician (208600000X) |
United | 19301 | $949.26 | 1679679229 - JAMES DELINE | 841505645 - SURGONE, P.C. | CO | Surgery Physician (208600000X) |
United | 19301 | $742.59 | 1124135348 - STEVEN KIM | 383988222 - (HI) EKAHI WELLNESS LLC | CO | Surgery Physician (208600000X) |
United | 19301 | $2238.18 | 1366754616 - DARNELL BROWN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | IN | Surgery Physician (208600000X) |
United | 19301 | $749.09 | 1568534667 - ACCELERATED RECOVERY SPECIALISTS | 202157413 - (CO) ACCELERATED RECOVERY SPECIALISTS PC | CO | Specialist (174400000X) |
United | 19301 | $762.40 | 1184863631 - PRADEEP RAI | 840816047 - (CO) PIKES PEAK HOSPICE AND PALLIATIVE CARE INC | CO | Surgery Physician (208600000X) |
United | 19301 | $912.40 | 1255644456 - JUN ELEGINO | 431639806 | MO | Surgery Physician (208600000X) |
United | 19301 | $2311.23 | 1033572961 - TIMOTHY IRWIN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | MA | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 19301 | $572.03 | 1659552040 - COLORADO OPHTHALMOLOGY ASSOCIATES PC | 840596940 - (CO) COLORADO OPHTHALMOLOGY ASSOCIATES PC | CO | Specialist (174400000X) |
United | 19301 | $953.39 | 1861503948 - FOUR CORNERS OB/GYN | 841451020 - (CO) FOUR CORNERS OB-GYN, LLP | CO | Specialist (174400000X) |
United | 19301 | $1919.00 | 1982206728 - FIRST CHOICE AMBULATORY SURGICAL CENTER LLC, LEGENT ASC MED CENTER | 852384947 - (TX) FIRST CHOICE AMBULATORY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19301 | $1100.58 | 1760876676 - NATHAN FROHNE | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | OH | Surgery Physician (208600000X) |
United | 19301 | $2194.31 | 1134625817 - HANNAH ROBINSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Medical Oncology Physician (207RX0202X) |
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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