HCPCS C7540 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Outpatient PPS • Miscellaneous Surgical Procedures |
| Complexity Level | Moderate |
National average reimbursement for HCPCS C7540 by major payers:
$298.64
$N/A
$30,833.90
$N/A
| 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 HCPCS C7540 | ||||||
United | C7540 | $1762.00 | 1043679327 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | C7540 | $6051.00 | 1750358297 - CITY OF HOPE NATIONAL MEDICAL CENTER | 951683875 - CITY OF HOPE NATIONAL MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | C7540 | $8336.00 | 1871556621 - ST. MARY'S HOSPITAL, INC., ST. MARY'S HOSPITAL | 580566223 - ST MARYS HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C7540 | $1162.00 | 1730761065 - BURKE HOSPITAL COMPANY, BURKE HEALTH | 853939331 - BURKE HOSPITAL COMPANY, LLC | GA | General Acute Care Hospital (282N00000X) |
United | C7540 | $13834.00 | 1952546616 - UNIVERSITY OF SOUTHERN CALIFORNIA, KECK HOSPITAL OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | C7540 | $6532.00 | 1972535318 - WELLSTAR SPALDING REGIONAL HOSPITAL, INC, WELLSTAR SPALDING REGIONAL HOSPITAL | 810864789 - (GA) WELLSTAR SPALDING REGIONAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C7540 | $1514.00 | 1861811614 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7540 | $13834.00 | 1790718500 - USC UNIVERSITY HOSPITAL, INC., USC HOSPITAL | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | Psychiatric Hospital Unit (273R00000X) |
United | C7540 | $1762.00 | 1952720708 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, MARICOPA INTEGRATED HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7540 | $1514.00 | 1104331115 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE CHC - MESA BEHAVIORAL HEALTH SPECIALTY CLINIC | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
United | C7540 | $7002.00 | 1780643411 - PIEDMONT MOUNTAINSIDE HOSPITAL, INC., PIEDMONT MOUNTAINSIDE HOSPITAL | 352228583 - (GA) PIEDMONT MOUNTAINSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C7540 | $1514.00 | 1295154045 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | Federally Qualified Health Center (FQHC) (261QF0400X) |
United | C7540 | $398.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7540 | $6045.00 | 1265486278 - EAST GEORGIA REGIONAL MEDICAL CENTER, LLC, EAST GEORGIA REGIONAL MEDICAL CENTER LLC | 582190713 - (GA) EAST GEORGIA REGIONAL MEDICAL CENTER LLC | GA | General Acute Care Hospital (282N00000X) |
United | C7540 | $1514.00 | 1851145809 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT | 860830701 | AZ | Adult Mental Health Clinic/Center (261QM0850X) |
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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HCPCS C7540 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7540 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. 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 HCPCS C7540 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 |
|---|---|---|
| C7539-HCPCS | Moderate | Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) |
| C7540-HCPCS | Moderate | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) |
| C7541-HCPCS | Moderate | Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7540 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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