CPT 29855 Fee Schedule
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.
| 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 29855 |
National average reimbursement for CPT 29855 by major payers:
$1,101.56
$1,061.68
$1,080.82
$1,321.64
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 29855 | ||||||
United | 29855 | $1364.43 | 1942683263 - JAMES ALSOP | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 29855 | $3750.00 | 1356099147 - HOPCO FLAGSTAFF ASC HOLDINGS, LLC, ELEVATION SURGERY CENTER | 851224752 - (AZ) HOPCO FLAGSTAFF ASC HOLDINGS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $5127.00 | 1861913220 - SJV MANAGEMENT, LLC, SOUTH JERSEY VASCULAR SURGERY CENTER | 202273476 - (NJ) SJV MANAGEMENT, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $3625.00 | 1053031237 - FRESENIUS VASCULAR CARE EL PASO ASC LLC | 861628275 - (TX) FRESENIUS VASCULAR CARE EL PASO ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $3012.00 | 1194275230 - WEST SUBURBAN EYE SURGERY CENTER LLC, SURGISITE NORTH | 201671234 - (MA) WEST SUBURBAN EYE SURGERY CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $2300.00 | 1295258416 - PUMPKIN PATCH AMBULATORY SURGICAL CENTER, LLC, ORLANDO AVENUE SURGERY CENTER, LLC | 475078896 - (FL) PUMPKIN PATCH AMBULATORY SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $5570.00 | 1174010011 - DTC SURGERY CENTER, LLC, OCC SURGERY CENTER AT INVERNESS | 825181311 - (CO) DTC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $3603.00 | 1679544290 - KEYSTONE SURGERY CENTER, LTD | 43712391 - (PA) KEYSTONE SURGERY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $1347.00 | 1154385813 - LOCKWOOD AMBULATORY SURGERY CENTER, GROMAN & RUBIN AMBULATORY SURGERY CENTER | 522219794 - (MD) LOCKWOOD AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $2671.00 | 1477876696 - KEY BISCAYNE SURGERY CENTER LLC | 271725488 - (FL) KEY BISCAYNE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $6365.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $1063.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $4484.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $2575.00 | 1457428005 - FLEMING ISLAND SURGERY CENTER | 202874196 - (FL) FLEMING ISLAND SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29855 | $6365.00 | 1942507488 - GA ENDOSCOPY CENTER, LLC | 273115800 - (GA) GA ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 29855 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 29855 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 29855 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 |
|---|---|---|
| 29851-CPT | High | Arthroscopically Aided Treatment Of Intercondylar Spine(S) And/Or Tuberosity Fracture(S) Of The Knee, With Or Without Manipulation; With Internal Or External Fixation (Includes Arthroscopy) |
| 29855-CPT | High | Arthroscopically Aided Treatment Of Tibial Fracture Proximal (Plateau); Unicondylar Includes Internal Fixation When Performed (Includes Arthroscopy) |
| 29856-CPT | High | Arthroscopically Aided Treatment Of Tibial Fracture Proximal (Plateau); Bicondylar Includes Internal Fixation When Performed (Includes Arthroscopy) |
| 29866-CPT | High | Arthroscopy, Knee, Surgical; Osteochondral Autograft - Medicaid Rn Review>=6/13/2009. Commercial Rn Review=6/13/2009-3/31/2022 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 29855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 29855 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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