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See a sample rate comparisonCPT 22904 Fee Schedule
Medicare rates as of October 2026
CPT 22904 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Abdomi Wal, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Abdominal Wal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | 51Multiple procedures 59Distinct Procedural Service |
| Hospital Outpatient Group (APC) | APC 5073 - Level 3 Excision/ Biopsy/ Incision and Drainage |
| Surgery Center Payment (ASC) | G2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $985.33 national non-facility rate (2026)View Medicare rates for 22904 |
| Medicaid Fee Schedule | $770.045 median of the 8 states in the free previewView Medicaid rates for 22904 |
National average reimbursement for CPT 22904 by major payers:
$1,370.37
BCBS / Anthem
$1,440.83
UnitedHealthcare
$1,445.05
Aetna
$1,722.90
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 22904.
CPT 22904
5 of 25 sample ratesHigher to lower in this preview
Ku Medwest Ambulatory Surgery Center, LLC
Ku Medwest Ambulatory Surgery Center LLC
$3,563.00Published rateWesthealth Surgery Center LLC
$1,259.00Published rateTallahassee Neurosugery Pain Management LLC, Tallahassee Memorial Center For Pain Management
Tallahassee Neurosugery Pain Management LLC
$966.00Published rateNephrology Vascular Lab Of Central Alabama Asc LLC
$558.00Published rateTranssouth Health Care PLLC, Transsouth Health Care PC
Transsouth Health Care, P.C.
$360.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 22904 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 22904. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 22900-CPT | Xcision Tumor Sft Tissue Of Abdomi Wall Subfasci (Eg Intram, Excision Tumor Soft Tissue Of Abdominal Wall Subfascial (Eg Intram |
| 22901-CPT | Xcision Tumor Sft Tissue Of Abdomi Wall Subfasci (Eg Intram, Excision Tumor Soft Tissue Of Abdominal Wall Subfascial (Eg Intram |
| 22904-CPT | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Abdomi Wal, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Abdominal Wal |
| 22905-CPT | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Abdomi Wal, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Abdominal Wal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22904 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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Frequently Asked Questions
What APC is CPT 22904 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 22904 to APC 5073 (Level 3 Excision/ Biopsy/ Incision and Drainage). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 22904 in an ambulatory surgery center?
CMS lists CPT 22904 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 22904?
Hospital price transparency files list CPT 22904 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.