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 |
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 | $200.00 | 1417118241 - DIGESTIVE HEALTH COMPLEX,INC | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1000.00 | 1396089108 - TRIANGLE ORTHOPAEDICS SURGERY CENTER | 275268935 - (NC) TRIANGLE ORTHOPAEDICS SURGERY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1274.00 | 1376906354 - PREMIER AT EXTON SURGERY CENTER, LLC | 474302293 - (PA) PREMIER AT EXTON SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $2732.00 | 1477140796 - PORTSMOUTH SURGICENTER, LLC | 833659705 - (NH) PORTSMOUTH SURGICENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1050.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $6068.00 | 1184877219 - THR/STT ROCKWALL ASC, LLC | 262429878 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $6813.54 | 1639517618 - MICHAEL DAUM | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 55970 | $713.00 | 1801343496 - TRADITION SURGERY CENTER, LLC | 364837780 - (FL) TRADITION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $430.00 | 1639142656 - GREENSBORO OPHTHALMOLOGY ASC LLC, SURGICAL EYE CENTER | 621842511 - (NC) GREENSBORO OPHTHALMOLOGY LLC, ASC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $927.00 | 1437116274 - SILVER SPRINGS SURGERY CENTER LLC | 431804124 - (MO) SILVER SPRINGS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $395.00 | 1952354326 - CENTER OF SURGICAL EXCELLENCE OF VENICE FLORIDA LLC | 202807874 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1955.00 | 1093383655 - SHERMAN ENDOSCOPY CENTER, LLC | 861402910 - (TX) SHERMAN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55970 | $1000.00 | 1225684368 - FORT WAYNE VASCULAR CARE LLC, NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA PC | 364859870 - (IN) FORT WAYNE VASCULAR CARE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $395.00 | 1134366370 - CENTER OF SURGICAL EXCELLENCE, COSE ANESTHESIA BILLING | 202807874 | FL | 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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