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See a sample rate comparisonHCPCS M1054 Fee Schedule
HCPCS M1054 is classified under Screening Procedures, in the Urgent Care Visit subgroup.
Patient had only urgent care visits during the performance period
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Urgent Care Visit |
| Complexity Level | Low |
National average reimbursement for HCPCS M1054 by major payers:
$70.12
BCBS / Anthem
$N/A
UnitedHealthcare
$49.42
Aetna
$N/A
Cigna
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HCPCS M1054
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M1054 vs. Other Urgent Care Visit Codes
The table lists codes related to M1054. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| M1052-HCPCS | Low | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively |
| M1054-HCPCS | Low | Patient had only urgent care visits during the performance period |
| M1055-HCPCS | Low | Aspirin or another antiplatelet therapy used |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1054. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1054 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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