CPT 19355 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 19355 |
National average reimbursement for CPT 19355 by major payers:
$920.07
$948.79
$952.74
$1,231.39
| 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 19355 | ||||||
United | 19355 | $1071.00 | 1639476377 - LIVONIA OUTPATIENT SURGERY CENTER, LLC | 261322609 - (MI) LIVONIA OUTPATIENT SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $2180.00 | 1225058068 - PROCEDURE CENTER OF IRVINE INC., PROCEDURE CENTER OF IRVINE | 330932503 - (CA) PROCEDURE CENTER OF IRVINE INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $4426.00 | 1285870303 - LAPORTE MEDICAL GROUP SURGICAL CENTER, LLC | 260505795 - (IN) LAPORTE MEDICAL GROUP SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $1839.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $2160.00 | 1093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC | 371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $4467.00 | 1457960536 - LAKE GEORGE SURGERY CENTER, LLC | 844411548 - (IN) LAKE GEORGE SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $1747.00 | 1184690570 - PAIN CARE SURGERY, PC | 371379699 - (IL) PAIN CARE SURGERY PC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $3347.00 | 1932636123 - TUCSON DIGESTIVE INSTITUTE LLC, ARIZONA DIGESTIVE INSTITUTE | 821568426 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $5726.00 | 1619944824 - WAVERLEY SURGERY CENTER LLC, WAVERLEY SURGERY CENTER | 20554398 - (CA) WAVERLEY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $4339.00 | 1205361052 - MINIMALLY INVASIVE SURGERY CENTER OF N.E., LLC | 815005653 | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $1868.00 | 1205076593 - HEALTHCARE PARTNERS ASC-HB, LLC, TALBERT SURGICAL ASSOCIATES, LLC | 264247365 - (CA) HEALTHCARE PARTNERS ASCHB LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $3570.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $6623.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $10081.00 | 1588618557 - COLUMBIA MEDICAL CENTER OF PLANO SUBSIDIARY LP, MEDICAL CITY PLANO | 621682203 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19355 | $3188.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | 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 19355 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19355 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 19355 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 |
|---|---|---|
| 19325-CPT | Moderate | Breast Augmentation With Implant (Desc Rvsd 1/1/21) |
| 19340-CPT | Moderate | Insertion Of Breast Implant On Same Day Of Mastectomy (Ie Immediate) (Desc Rvsd 1/1/21) |
| 19342-CPT | High | Insertion Or Replacement Of Breast Implant On Separate Day From Mastectomy (Desc Rvsd 1/1/21) |
| 19355-CPT | Moderate | Correction Of Inverted Nipples- Deny Cos/N09 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19355 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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