CPT 29807 Fee Schedule

A CPT (Current Procedural Terminology) code is a standardized set of five-digit codes used by medical professionals to describe medical, surgical, and diagnostic services. These codes are crucial for medical billing because they enable healthcare providers, insurers, and government programs to communicate consistently about the specific services rendered. This consistency facilitates accurate processing of claims and ensures proper payment for healthcare services.

To find the cost of a specific medical procedure or service, you should first contact your healthcare provider's billing department for an estimated cost. Additionally, reach out to your insurance company to understand your coverage, including deductibles, co-pays, and your out-of-pocket maximums for that service. For a more detailed search based on specific CPT codes and your geographic location, you can use tools like Payerprice, which provides fee schedule lookup functionalities.

An 'in-network' provider has a contractual agreement with your health insurance plan to provide services at pre-negotiated rates. When you receive care from an in-network provider, you typically pay less out of pocket because your insurer covers a larger portion of the cost. An 'out-of-network' provider, conversely, does not have a contract with your insurance plan. While your plan may still cover some costs, you usually incur a higher percentage of the bill, and the provider might 'balance bill' you for the difference between their charged amount and what your insurance plan pays.

Medical costs can vary significantly due to multiple factors. These include the type of healthcare facility (e.g., a hospital versus an outpatient clinic), the geographical location, the specific services performed, the provider's experience and reputation, and the negotiated rates with different insurance companies. Other contributing factors often include the complexity of the procedure, the technology used, and the facility's overhead costs.

For detailed information on healthcare prices tailored to your specific situation, including the ability to search by CPT code and location, it is highly recommended to use resources such as Payerprice. They offer specialized fee schedule lookup tools that can help you understand potential costs for various medical services. Always remember to also consult your insurance provider to fully understand your specific benefits, coverage, and any out-of-pocket expenses.

Medicare's hospital outpatient payment system (OPPS) assigns CPT 29807 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.

CMS lists CPT 29807 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.

CMS add-on code edits list CPT 29807 as a primary code for these add-on codes: 29826.

Hospital price transparency files list CPT 29807 under these revenue codes: including 0360, 0975, 0960, 0989 and 0490. A revenue code names the hospital department or charge category for the line; it does not change what the service is.