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See a sample rate comparisonCPT 29805 Fee Schedule
CPT 29805 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Scope Exam Of Shoulder, Exam Of A Shoulder Using A Scope (Arthroscopy). 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 | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | 59Distinct Procedural Service 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 | 03600960Sign up to view all 5 |
| Medicare Fee Schedule | View Medicare rates for 29805 |
| Medicaid Fee Schedule | $359.125 median of the 8 states in the free previewView Medicaid rates for 29805 |
National average reimbursement for CPT 29805 by major payers:
$637.96
BCBS / Anthem
$634.68
UnitedHealthcare
$655.51
Aetna
$775.00
Cigna
Compare published rates across providers.
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CPT 29805
5 of 25 sample ratesHigher to lower in this preview
Inova Loudoun Ambulatory Surgery
$6,530.00Published ratePioneer Valley Surgicenter LLC, Pioneer Valley Surgicenter
Pioneer Valley Surgicenter, LLC
$3,484.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$2,703.00Published rateUpper Cumberland Physicians Surgery Center LLC
$1,452.00Published rateDanielle Fisher
Deaconess Hospital Inc
$376.80Published rate
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See a sample payer proposalCPT 29805 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 29805. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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. |
| 29807-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. |
| 29819-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 29805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 29805 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 29805 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 29805 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 29805 in an ambulatory surgery center?
CMS lists CPT 29805 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 29805?
Hospital price transparency files list CPT 29805 under these revenue codes: 0360, 0960, 0636, 0761 and 0975. A revenue code names the hospital department or charge category for the line; it does not change what the service is.