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.

How can I find the cost of a specific medical procedure or service?

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.

How do insurance plans affect the cost I pay for medical services?

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.

What is the No Surprises Act?

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.

Where can I compare prices for healthcare services in my area?

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.

CPT 29806 Fee Schedule

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

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.

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Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Musculoskeletal System
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 29806
Medicaid Fee Schedule	View Medicaid rates for 29806

National average reimbursement for CPT 29806 by major payers:

$1,487.73

$1,433.50

$1,533.30

$1,736.36

CPT 29806 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 29806 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 29806 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
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). Check Rates
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. Check Rates
29807-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. Check Rates
29819-CPT	Moderate	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. Check Rates

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 29806. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 29806 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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