CPT 25085 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 | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25085 |
National average reimbursement for CPT 25085 by major payers:
$629.40
$618.82
$637.83
$773.49
| 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 25085 | ||||||
United | 25085 | $649.00 | 1447748470 - CTS SURGICAL ASSOCIATES LLC, CEDAR TREE SURGICAL CENTER | 825298503 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $700.00 | 1679605729 - METROPOLITAN SURGICAL ASSOCIATES INC. DBA METROPOLITAN MEDICAL ASSOC | 222306421 - (NJ) METROPOLITAN SURGICAL ASSOCIATES, INC. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1435.00 | 1134665193 - NHPE, LLC, NEW HYDE PARK ENDOSCOPY | 471158058 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $972.00 | 1821250176 - NORTHSHORE AMBULATORY SURGERY CENTER LLC | 800352092 - (LA) NORTHSHORE AMBULATORY SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $861.00 | 1972522985 - MIDDLESEX ENDOSCOPY CENTER LLC | 20722190 - (CT) MIDDLESEX ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $2595.00 | 1669465209 - FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY LP, HUNTINGDON VALLEY SURGERY CENTER | 680499459 - (PA) FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $2119.00 | 1073613162 - ROCKY MOUNTAIN SURGERY CENTER LLC | 870699657 - (CO) ROCKY MOUNTAIN SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1339.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1915.00 | 1013471754 - ADVANCED SURGERY CENTER OF LANCASTER, LLC | 831133719 - (PA) ADVANCED SURGERY CENTER OF LANCASTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $654.00 | 1093907339 - TAYLOR SURGERY CENTER, LLC, SURGICAL ARTS SURGERY CENTER | 710860395 - (AR) TAYLOR SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1514.00 | 1689814998 - PUGET SOUND SURGICAL CLINIC INC | 911687859 - (WA) PUGET SOUND SURGICAL CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1485.00 | 1124099635 - HUNTINGTON SURGERY CENTER LIMITED PARTNERSHIP, CABELL HUNTINGTON SURGERY CENTER | 550647724 - (WV) CABELL HUNTINGTON SURGERY CENTER | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $1259.00 | 1285692004 - TEC NORTH, LLC, THE ENDOSCOPY CENTER NORTH | 201871076 - (TN) TEC NORTH LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $2353.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25085 | $3599.00 | 1386647527 - ORTHOPEDIC SURGERY CENTER OF OC LLC | 330841806 | 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 25085 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25085 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 25085 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 |
|---|---|---|
| 25071-CPT | Moderate | Exc Tumor Soft Tiss Forearm And Wrist Subq 3 Cm |
| 25075-CPT | Moderate | Removal (Less Than 3 Centimeters) Tissue Growth Beneath The Skin At Forearm And/Or Wrist |
| 25076-CPT | Moderate | Excision, Tumor, Soft Tissue Of Forearm And/Or Wrist Area, Subfascial (Eg, Intramuscular); Less Than 3 Cm |
| 25085-CPT | Moderate | Capsulotomy, Wrist-For Contracture |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25085. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25085 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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