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 |
National average reimbursement for CPT 29804 by major payers:
$881.79
$851.55
$886.90
$1,042.07
| 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 29804 | ||||||
United | 29804 | $4275.00 | 1073569562 - GRAMERCY SURGERY CENTER, INC | 204336660 - (NY) GRAMERCY SURGERY CENTER, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1818.00 | 1144200163 - ABILENE ASC LP, ABILENE ENDOSCOPY CENTER | 621562008 - (TX) ABILENE ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1858.00 | 1558807131 - MIDWEST NEPHROLOGY ASSOCIATES, SC, MNA SURGERY CENTER | 391707770 - (WI) MIDWEST NEPHROLOGY ASSOCIATES, SC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $6225.00 | 1386165504 - THE EMORY CLINIC INC, EMORY AMBULATORY SURGERY CENTER AT SPIVEY STATION | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1505.00 | 1194291401 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $4696.00 | 1255353389 - SOMERSET AMBULATORY SURGICAL CENTER, LLC | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $2010.00 | 1437636636 - CCRM DFW, LLC, CCRM DALLAS FORT WORTH | 822959456 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1500.00 | 1053852236 - SURGERY CENTER OF ANAHEIM HILLS, LLC | 814260687 - (CA) SURGERY CENTER OF ANAHEIM HILLS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1860.00 | 1396266441 - EYE SURGERY CENTER OF EAST TEXAS LLC | 811881035 - (TX) EYE SURGERY CENTER OF EAST TEXAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1549.00 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $6410.00 | 1740236454 - PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC, PRINCESS ANNE AMBULATORY SURGERY CENTER | 204920880 - (VA) PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1539.00 | 1386737021 - ARKANSAS OUTPATIENT EYE SURGERY LLC, MCDONALD EYE ASSOCIATES SURGERY AND LASIK CENTER | 752777970 - (AR) ARKANSAS OUTPATIENT EYE SURGERY LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1750.00 | 1083955330 - BELLEVUE PLASTIC SURGERY CENTER, NEWVUE PLASTIC SURGERY PC | 263374369 - (WA) NEWVUE PLASTIC SURGERY, PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $3500.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29804 | $1255.00 | 1306005343 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | 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 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 | Arthroscopy, Temporomandibular Joint Diagnostic With Or Without Synovial Biopsy- Medicaid: Nr >=5/10/12; Commercial: Nr 5/10/12-12/31/13 |
| 29804-CPT | Moderate | Arthroscopy Temporomandibular Jt Surgica |
| 29805-CPT | Moderate | Arthroscopy, Shoulder, Diagnostic, With Or Without Synovial Biopsy (Separate Procedure) |
| 29806-CPT | High | Repair Of Shoulder Joint Capsule Using An Endoscope |
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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