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See a sample rate comparisonCPT 29804 Fee Schedule
Medicare rates as of October 2026
CPT 29804 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22On Campus Outpatient Hospital 24Ambulatory Surgical Center |
| Common Modifiers | 50Bilateral Procedure RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5113 - Level 3 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $541.76 national non-facility rate (2026)View Medicare rates for 29804 |
| Medicaid Fee Schedule | $439.44 median of the 8 states in the free previewView Medicaid rates for 29804 |
National average reimbursement for CPT 29804 by major payers:
$881.79
BCBS / Anthem
$851.55
UnitedHealthcare
$886.90
Aetna
$1,019.79
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 29804.
CPT 29804
5 of 25 sample ratesHigher to lower in this preview
Princess Anne Ambulatory Surgery Management LLC, Princess Anne Ambulatory Surgery Center
Princess Anne Ambulatory Surgery Management, LLC
$6,410.00Published rateSkyway Surgery Center, LLC
Skyway Surgery Center LLC
$3,500.00Published rateLonestar Ambulatory Surgical Center
$2,010.00Published ratePacific Cataract And Laser Institute, Inc., P.C.
Pacific Cataract And Laser Institute, Inc., PC
$1,549.00Published rateLivonia Outpatient Surgery Center, LLC
Livonia Outpatient Surgery Center LLC
$1,071.00Published rate
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See a sample payer proposalCPT 29804 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 29804. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 29800-CPT | 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 | 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 | 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 | 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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Frequently Asked Questions
What APC is CPT 29804 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 29804 to APC 5113 (Level 3 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 29804 in an ambulatory surgery center?
CMS lists CPT 29804 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 29804?
Hospital price transparency files list CPT 29804 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.