CPT 41005 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 41005 |
National average reimbursement for CPT 41005 by major payers:
$270.40
$284.62
$303.34
$372.11
| 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 41005 | ||||||
United | 41005 | $82.00 | 1336439645 - ACADEMIC UROLOGY OF PA, LLC | 205328092 - (PA) ACADEMIC UROLOGY OF PA, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $42.00 | 1609026533 - EYE SURGICENTER LLC | 651005108 - (FL) EYE SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $92.00 | 1811512734 - SSL ENDOSCOPY CENTER LLC, AVALA SURGERY CENTER | 843735506 - (LA) SSL ENDOSCOPY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $555.00 | 1215548524 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $300.00 | 1346918646 - TIMPVIEW ASC, LLC | 872314348 - (UT) TIMPVIEW ASC LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $200.00 | 1568420388 - GREAT LAKES SURGICAL CENTER LLC | 562350398 - (MI) GREAT LAKES SURGICAL CENTER LL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $1446.00 | 1316359532 - LONE STAR ENDOSCOPY CENTER, LLC | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $230.00 | 1508438375 - BSC REID PARK LLC | 870858924 - (AZ) BSC REID PARK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $213.00 | 1104990050 - FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | 911798298 - (NM) FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $566.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $342.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $383.00 | 1497745178 - SURGERY CENTER, DBA SAWTOOTH SURGERY CENTER | 823348107 - (ID) SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $803.00 | 1386647527 - ORTHOPEDIC SURGERY CENTER OF OC LLC | 330841806 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $86.00 | 1326379967 - WEIR ASC, LLC, SOUTHWEST EYE SURGERY CENTER | 271659546 - (OK) WEIR ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 41005 | $688.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | 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 41005 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 41005 code is part of the Surgery services used for Surgical Procedures on the Digestive 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 41005 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 |
|---|---|---|
| 41000-CPT | Low | I&D Les Intraoral Lingual |
| 41005-CPT | Moderate | I&D Les Intraoral Sublingual |
| 41006-CPT | Moderate | Intraoral Incision And Drainage Of Abscess, Cyst, Or Hematoma Of Tongue Or Floor Of Mouth; Sublingual, Deep, Supramylohyoid |
| 41007-CPT | Moderate | Intraoral I&D-Cyst..Tongue-Floor;Subment |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 41005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 41005 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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