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See a sample rate comparisonCPT 69604 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.
Remove Bone Behind The Ear, Surgery To Remove The Bone Behind The Ear (Mastoid) And To Reconstruct The Eardrum (Tympanic Membrane).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Auditory System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 69604 |
| Medicaid Fee Schedule | View Medicaid rates for 69604 |
National average reimbursement for CPT 69604 by major payers:
$1,485.78
$1,438.62
$1,482.15
$1,818.13
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CPT 69604
5 of 25 sample ratesHigher to lower in this preview
Marin Health Ventures, LLC, Marin Specialty Surgery Center
Marin Health Ventures, Inc. Dba Marin Specialty Surgery Center
$7,827.00Published rateCentral Delaware Endoscopy Unit LLC
$5,433.00Published rateEltra LLC
$3,100.00Published ratePhysicians' Surgery Center, LLC
Physicians Surgery Center, L.L.C.
$2,087.00Published rateKingsport Endoscopy Corporation
$425.00Published rate
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See a sample payer proposalCPT 69604 vs. Other Surgical Procedures on the Auditory System Codes
The CPT 69604 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 69604 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 |
|---|---|---|
| 69601-CPT | High | Revis.Mastoidectomy;Results:Compl Mastoi |
| 69603-CPT | High | Remove Bones In And Near Ear, Surgery To Remove The Mastoid Bone (Bone Behind The Ear) As Well As All Of The Bones Of The Middle Ear. |
| 69604-CPT | High | Remove Bone Behind The Ear, Surgery To Remove The Bone Behind The Ear (Mastoid) And To Reconstruct The Eardrum (Tympanic Membrane). |
| 69620-CPT | Moderate | Myringoplasty Uncomplicated |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 69604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 69604 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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