CPT 22905 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22905 |
| Medicaid Fee Schedule | View Medicaid rates for 22905 |
National average reimbursement for CPT 22905 by major payers:
$1,674.68
$1,834.71
$1,863.49
$2,181.72
CPT 22905 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22905 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 22905 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 |
|---|---|---|
| 22900-CPT | Moderate | Xcision Tumor Sft Tissue Of Abdomi Wall Subfasci (Eg Intram, Excision Tumor Soft Tissue Of Abdominal Wall Subfascial (Eg Intram |
| 22901-CPT | Moderate | Xcision Tumor Sft Tissue Of Abdomi Wall Subfasci (Eg Intram, Excision Tumor Soft Tissue Of Abdominal Wall Subfascial (Eg Intram |
| 22904-CPT | High | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Abdomi Wal, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Abdominal Wal |
| 22905-CPT | High | 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 22905. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22905 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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