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See a sample rate comparisonCPT 69540 Fee Schedule
Last Verified: October 2026
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.
Excision Aural Polyp
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Auditory System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 69540 |
| Medicaid Fee Schedule | View Medicaid rates for 69540 |
National average reimbursement for CPT 69540 by major payers:
$260.83
$261.85
$270.99
$222.10
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CPT 69540
5 of 25 sample ratesHigher to lower in this preview
Voorhees Surgery Center, LLC
Voorhees Surgery Center LLC
$1,200.00Published rateNorth Care Asc, LLC
North Care Asc LLC
$765.00Published ratePain Management Professionals Of Baytown PLLC, Advanced Pain Management Specialists Of Baytown
Pain Management Professionals Of Baytown PLLC
$615.00Published rateEndoscopy Associates, LLC
Endoscopy Associates LLC
$500.00Published rateKristen Browning
Deaconess Hospital Inc
$165.38Published rate
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See a sample payer proposalCPT 69540 vs. Other Surgical Procedures on the Auditory System Codes
The CPT 69540 code is part of the Surgery services used for Surgical Procedures on the Auditory 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 69540 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 69540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 69540 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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