CPT 22903 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 Musculoskeletal System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 22903 |
National average reimbursement for CPT 22903 by major payers:
$534.91
$602.47
$623.47
$750.67
| 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 22903 | ||||||
United | 22903 | $7900.64 | 1144348194 - ALLE-KISKI MEDICAL CENTER | 251875178 - (PA) HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $2859.00 | 1013068642 - RENAISSANCE SURGERY CENTER, LLC | 205977652 - (CA) RENAISSANCE SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $1685.00 | 1831368356 - VERMONT EYE SURGERY & LASER CENTER | 204872230 - (VT) VERMONT EYE SURGERY & LASER CENTER, LLC 401(K) PLAN | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $2353.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $1915.00 | 1962676304 - 32ND STREET SURGERY CENTER, LLC | 261339811 - (MO) 32ND STREET SURGERY CENTER, L.L.C. | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $2307.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $900.00 | 1669181822 - ALLIANCE SURGERY CENTER AT CUMMING | 881953675 - (GA) ALLIANCE SURGERY CENTER AT CUMMING | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $774.00 | 1407247208 - COLONOSCOPY AND ENDOSCOPY CENTER LLC | 471628673 - (OH) COLONOSCOPY AND ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $2307.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $734.00 | 1275178444 - KENOSHA DIGESTIVE HEALTH CENTER LLC | 842167873 - (WI) KENOSHA DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $3013.00 | 1548560600 - REX SURGERY CENTER OF CARY LLC | 273684056 - (NC) REX SURGERY CENTER OF CARY LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $721.00 | 1972541415 - OCEAN ENDOSURGERY CENTER LLC, OCEAN ENDOSURGERY CENTER | 223564617 - (NJ) OCEAN ENDOSURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $2307.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $1547.00 | 1902960206 - SINUS SURGERY CENTER IDAHO PA | 205282962 - (ID) SINUS SURGERY CENTER IDAHO PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22903 | $1600.00 | 1093766735 - TAMPA BAY SURGERY CENTER ASSOCIATES,LTD | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | 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 22903 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22903 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 22903 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 |
|---|---|---|
| 22901-CPT | Moderate | Exc Tumor Soft Tissue Abdl Wall Subfascial 5 Cm |
| 22902-CPT | Moderate | Exc Tumor Soft Tissue Abdominal Wall Subq 3cm |
| 22903-CPT | Moderate | Exc Tumor Soft Tissue Abdominal Wall Subq 3 Cm |
| 22904-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Abdominal Wall; Less Than 5 Cm (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22903. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22903 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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