CPT 29806 Fee Schedule

CPT stands for Current Procedural Terminology. CPT codes are a standardized set of medical codes used by healthcare professionals, insurance companies, and billing departments to describe medical, surgical, and diagnostic services and procedures. They are essential for accurate billing, processing insurance claims, and tracking healthcare services.

To find the estimated cost of a specific medical procedure or service, especially one associated with a CPT code in your specific location, you can utilize online price transparency tools. We recommend using Payerprice's fee schedule lookup tool. It allows you to search with a CPT code and your specific location to get an estimated cost, helping you understand potential out-of-pocket expenses before your appointment.

A fee schedule is a comprehensive list of maximum fees or negotiated rates that an insurance company or healthcare payer will reimburse for specific medical procedures, services, or supplies. These schedules vary significantly by payer, geographic region, and the type of service, and they dictate the financial terms between providers and payers.

Insurance plans significantly impact your out-of-pocket costs by covering a portion of medical expenses. The amount you pay depends on factors like your deductible, copayment, coinsurance, and whether the provider is in-network or out-of-network. Your plan's fee schedule determines how much the insurer will pay for a service, and you are responsible for the remaining balance up to your out-of-pocket maximum.

The No Surprises Act is a federal law implemented to protect individuals from unexpected medical bills. It primarily targets surprise billing for emergency services or non-emergency services received from out-of-network providers at an in-network facility. Under this act, patients are generally only responsible for their in-network cost-sharing amounts in such situations.

To compare prices for healthcare services in your specific area, we recommend utilizing price transparency tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can input a CPT code and your location to search for and compare the costs of various medical procedures and services. This helps you make more informed decisions about your healthcare expenses.

Medicare's hospital outpatient payment system (OPPS) assigns CPT 29806 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.

CMS lists CPT 29806 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.

CMS add-on code edits list CPT 29806 as a primary code for these add-on codes: 29826.

Hospital price transparency files list CPT 29806 under these revenue codes: including 0360, 0975, 0960, 0490 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.