CPT 55970 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 • 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 |
National average reimbursement for CPT 55970 by major payers:
$5,538.54
$5,049.33
$5,899.13
$5,783.35
| 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 55970 | ||||||
United | 55970 | $499.00 | 1811001548 - AMBULATORY SURGERY CENTER OF OPELOUSAS | 721502278 - (LA) AMBULATORY SURGERY CENTER OF O | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $575.00 | 1689608697 - ADVANCED COLON CARE INC, SHORELINE COLONOSCOPY SUITES | 61562707 - (CT) ADVANCED COLON CARE INC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $524.00 | 1447366224 - WEST MICHIGAN SURGERY CENTER, LLC | 371509502 - (MI) MICHIGAN PRIMARY CARE PARTNERS PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $405.00 | 1588644520 - WESTGLEN ENDOSCOPY CENTER LLC, WESTGLEN ENDOSCOPY CENTER | 621707329 - WESTGLEN ENDOSCOPY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $425.00 | 1972156842 - NORMAN REGIONAL HOSPITAL AUTHORITY, MEDICAL PLAZA ENDOSCOPY | 736048282 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $725.00 | 1598412256 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $451.00 | 1972096568 - NUVISION SAME DAY PROCEDURE CENTER LLC | 830820085 - (TX) NUVISION SAME DAY PROCEDURE CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $451.00 | 1285065490 - MASON ESC, LLC, MASON EYE SURGERY CENTER | 462015301 - (NY) MASON ESC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $3418.00 | 1265404115 - WILLMAR MEDICAL SERVICES, LLP | 823166379 - (MN) CARRIS HEALTH LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $289.00 | 1598847139 - ORTHOPAEDIC ASSOCIATES SURGERY CENTER, LLC | 582623564 - (GA) ORTHOPAEDIC ASSOCIATES SURGERY CTR, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $200.00 | 1073601332 - LISA RENFRO SURGERY CENTER LLC | 43612312 - (MD) LISA RENFRO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1274.00 | 1194351833 - DELRAY BEACH ASC, LLC, DELRAY BEACH SURGERY CENTER | 843067076 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $6813.54 | 1639517618 - MICHAEL DAUM | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 55970 | $125.00 | 1457490872 - HSC SURGICAL ASSOCIATES, FAIRFIELD ENDOSCOPY CENTER | 311386408 - (OH) HSC SURGICAL ASSOCIATES OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $145.00 | 1225452303 - MARTHA JEFFERSON HOSPITAL, MARTHA JEFFERSON OUTPATIENT SURGERY CENTER | 540261840 - (VA) MARTHA JEFFERSON HOSPITAL | VA | 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 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 | Excision Of Mullerian Duct Cyst |
| 55920-CPT | Moderate | Placement Of Needles Or Catheters Into Pelvic Organs And/Or Genitalia (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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