CPT 25115 Fee Schedule
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.
| 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 | High |
National average reimbursement for CPT 25115 by major payers:
$1,065.58
$1,054.78
$1,070.63
$1,301.66
| 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 25115 | ||||||
United | 25115 | $1675.00 | 1891889945 - DIGESTIVE CARE MEDICAL CENTER INC | 753037371 - (CA) DIGESTIVE CARE MEDICAL CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $4697.00 | 1427049352 - CENTER FOR AMBULATORY SURGERY, LLC, THE CENTER FOR AMBULATORY SURGERY | 223638149 - (NJ) THE CENTER FOR AMBULATORY SURGERY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1500.00 | 1750521720 - SPOKANE VALLEY EAR NOSE & THROAT PS, SPOKANE VALLEY AMBULATORY SURGERY CENTER | 911072626 - (WA) SPOKANE VALLEY EAR, NOSE & THROAT, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1847.00 | 1083686208 - WICHITA ORTHOPAEDIC ASC LLC, SURGERY CENTER OF KANSAS | 621659908 - (KS) WICHITA ORTHOPAEDIC ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1050.00 | 1376616060 - NORTHSHORE SURGICAL CENTER, LLC | 202339324 - (LA) NORTHSHORE SURGICAL CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1229.00 | 1205878758 - ALBUQUERQUE AMBULATORY EYE SURGERY CENTER, LLC | 850481490 - (NM) ALBUQUERQUE AMBULATORY EYE SURGERY CENTER LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1505.00 | 1821361130 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC SHOWLOW | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $650.00 | 1962609560 - FRONT RANGE ENDOSCOPY CENTERS, LLC | 205008349 - (CO) FRONT RANGE ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $650.00 | 1881875227 - SKIN & MOHS SURGERY CENTER, LLC | 431823843 - SKIN MOHS SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $986.00 | 1295841666 - SURGERY CENTER OF SANDUSKY LLC, SURGERY CENTER OF SANDUSKY | 204913215 - (OH) SURGERY CENTER OF SANDUSKY LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $825.00 | 1649735861 - KURESMART PAIN MANAGEMENT SURGERY CENTER-CATONSVILLE LLC, CLEARWAY SURGERY CENTER OF CATONSVILLE | 832414671 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCATONSVILLE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1750.00 | 1295209286 - OCONEE SURGERY CENTER | 832067040 - (GA) OCONEE SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1120.00 | 1154322600 - TEXOMA OUTPATIENT SURGERY CENTER, INC. | 752597635 - (TX) TEXOMA OUTPATIENT SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1200.00 | 1831801117 - SIGHT PARTNERS, LLC, EMPIRE EYE PHYSICIANS | 833467355 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25115 | $1574.00 | 1881738607 - NACOGDOCHES COUNTY HOSPITAL DISTRICT, NACOGDOCHES MEMORIAL HOSPITAL DAY SURG CIDC | 871142127 - (TX) LION STAR NACOGDOCHES HOSPITAL, LLC DBA NACOGDOCHES MEMORIAL HOSPITAL | TX | 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 25115 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25115 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 25115 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 |
|---|---|---|
| 25109-CPT | Moderate | Excision Of Tendon Forearm And Or Wrist Flexor Or Extensor Each |
| 25110-CPT | Moderate | Exc Lesion Tendon Sheath Forearm |
| 25115-CPT | High | Radical Excision Of Bursa, Synovia Of Wrist, Or Forearm Tendon Sheaths (Eg, Tenosynovitis, Fungus, Tbc, Or Other Granulomas, Rheumatoid Arthritis); Flexors |
| 25116-CPT | Moderate | Radical Excision Of Bursa, Synovia Of Wrist, Or Forearm Tendon Sheaths (Eg, Tenosynovitis, Fungus, Tbc, Or Other Granulomas, Rheumatoid Arthritis); Extensors, With Or Without Transposition Of Dorsal Retinaculum |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25115. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25115 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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