CPT 55980 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 • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 55980 |
National average reimbursement for CPT 55980 by major payers:
$5,473.34
$5,404.54
$5,092.50
$6,301.55
| 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 55980 | ||||||
United | 55980 | $4300.00 | 1790876431 - MAIN LINE SPINE SURGERY CENTER, LLC | 202547795 - (PA) MAIN LINE SPINE SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $622.00 | 1801952783 - AMBULATORY SURGICENTER OF DOWNERS GROVE | 364106726 - (IL) AMBULATORY SURGICENTER OF DOWNERS GROVE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $3304.80 | 1881047215 - JOHNATHON LANNAN | 350593390 - DEACONESS HOSPITAL INC | TX | Certified Registered Nurse Anesthetist (367500000X) |
United | 55980 | $693.00 | 1841325214 - AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | 208422547 - (MD) AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $2668.00 | 1871838003 - NORTHWEST REGIONAL SURGERY CENTER, LLC | 460823847 - (IN) NORTHWEST REGIONAL SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $680.00 | 1164946984 - NORTHWEST RENAL CLINIC, INC., NORTHWEST DIALYSIS ACCESS CENTER | 930751490 - (OR) NORTHWEST RENAL CLINIC, PC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $400.00 | 1083624225 - UNIVERSITY OF MARYLAND SURGCIAL ASSOC PA, UNIVERSITY OF MARYLAND UROLOGICAL SURGERY CENTER | 521557551 - (MD) UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES P A | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $565.00 | 1841711942 - MACON VASCULAR CARE, LLC | 320415161 - (GA) MACON VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $800.00 | 1154959179 - MUNSTER SURGERY CENTER LLC | 844828519 - (IN) MUNSTER SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $475.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $2785.00 | 1447364682 - RIDGE VIEW ENDOSCOPY CENTER | 800688043 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $203.00 | 1285736207 - PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER, PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC | 522197193 - (MD) PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $700.00 | 1760807127 - PHYSICIANS SURGERY CENTER AT GLENDALE ADVENTIST, LLC | 464085815 - (CA) PHYSICIANS SURGERY CENTER AT GLENDALE ADVENTIST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $750.00 | 1003802950 - MINNESOTA EYE INSTITUTE SURGERY CENTER, LLC | 550837369 - (MN) MINNESOTA EYE INSTITUTE SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 55980 | $102.00 | 1407932619 - PACIFIC EYE INSTITUTE A MEDICAL GROUP INC, PACIFIC EYE INSTITUTE AMBULATORY SURGERY CTR | 330303507 - (CA) PACIFIC EYE INSTITUTE MEDICAL CORPORATION | CA | 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 55980 vs. Other Intersex Surgery Codes
The CPT 55980 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 55980 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 55980. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55980 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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