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See a sample rate comparisonCPT 55970 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.
Intersex Op Male To Female
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Intersex Surgery |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None KX - Requirements specified in the medical policy have been met 50 - Bilateral Procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 55970 |
| Medicaid Fee Schedule | View Medicaid rates for 55970 |
National average reimbursement for CPT 55970 by major payers:
$5,538.54
$5,049.33
$5,899.13
$5,567.45
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CPT 55970
5 of 25 sample ratesHigher to lower in this preview
Michael Daum
Deaconess Hospital Inc
$6,813.54Published rateApple Valley Surgery Center
Persepolis Group LLC
$740.00Published rateAmbulatory Surgery Center Of Opelousas
Ambulatory Surgery Center Of O
$499.00Published rateNorman Regional Hospital Authority, Medical Plaza Endoscopy
$425.00Published rateHsc Surgical Associates, Fairfield Endoscopy Center
Hsc Surgical Associates Of Cincinnati, LLC
$125.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 55970 vs. Other Intersex Surgery Codes
The CPT 55970 code is part of the Surgery services used for Intersex Surgery. 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 55970 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 |
|---|---|---|
| 55680-CPT | Moderate | Remove Genital Cyst, Surgery To Remove A Pocket Of Fluid (Cyst) From The Duct Located Near The Seminal Vesicles (Paired Glands That Produce Fluid For Semen). |
| 55920-CPT | Moderate | General Surgery, Placement Of Needles Or Catheters Into Pelvic Organs And/Or Genitalia (Except Prostate) For Subsequent Interstitial Radioelement Application (Except Prostate) For Subsequent Interstitial Radioelement Application |
| 55970-CPT | High | Intersex Op Male To Female |
| 55980-CPT | High | Intersex Surgery;Female To Male |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55970. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55970 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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