CPT 29804 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 50 - Bilateral Procedure RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 29804 |
| Medicaid Fee Schedule | View Medicaid rates for 29804 |
National average reimbursement for CPT 29804 by major payers:
$881.79
$851.55
$886.90
$1,019.79
CPT 29804 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 29804 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 29804 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 |
|---|---|---|
| 29800-CPT | Moderate | Jaw Joint Surgery With A Scope, Surgery Aided By A Scope (Arthroscopy) To Examine The Jaw Joint (Tmj). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 29804-CPT | Moderate | Jaw Joint Surgery With A Scope, Surgery Aided By A Scope (Arthroscopy) To Examine The Jaw Joint (Tmj). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 29805-CPT | Moderate | Scope Exam Of Shoulder, Exam Of A Shoulder Using A Scope (Arthroscopy). The Procedure May Include Taking A Sample Of Tissue For Testing (Biopsy). |
| 29806-CPT | High | Surgery To Repair Shoulder, Surgery Aided By A Scope (Arthroscopy) To Repair The Shoulder Joint. The Procedure Removes Loose Tissue Or Foreign Objects As Well As Repairing Torn Cartilage Or Tissue. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 29804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 29804 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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