CPT 25259 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 25259 by major payers:
$590.45
$554.21
$569.56
$720.86
| 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 25259 | ||||||
United | 25259 | $470.00 | 1821068289 - CITRUS UROLOGY CENTER, INC., LECANTO SURGERY CENTER | 593387636 - (FL) CITRUS UROLOGY CENTER, INC DBA LECANTO SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $732.03 | 1003892035 - SRIDHAR BHASKARA | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 25259 | $600.00 | 1174530752 - LAKE MARY SURGERY CENTER LLC | 134215228 - (FL) LAKE MARY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $1082.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $514.00 | 1588603351 - PHYSICIAN'S DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $489.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $658.00 | 1174850176 - SOUTHWEST OHIO PAIN MANAGEMENT LLC | 300571536 - (OH) SOUTHWEST OHIO PAIN MANAGEMENT | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $650.00 | 1497368013 - PHYSICIANS REGIONAL SURGERY CENTER LLC | 842179117 - (OH) PHYSICIANS REGIONAL SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $471.00 | 1902958226 - AMBULATORY SURGERY CENTER OF TUCSON, INC. | 262420656 - (AZ) AMBULATORY SURGERY CENTER OF TUCSON INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $645.00 | 1316991938 - SURGICAL AND DIAGNOSTIC CENTER, L.P. | 752874229 - (TX) SURGICAL AND DIAGNOSTIC CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $410.00 | 1255311635 - MELBOURNE ASC LP, THE SURGERY CENTER OF MELBOURNE | 621625311 - (FL) MELBOURNE ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $1233.00 | 1023349909 - PICCARD SURGERY CENTER, LLC | 270433723 - (MD) PICCARD SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $702.00 | 1558480947 - ISSAQUAH FOOT & ANKLE SPECIALISTS PLLC | 454029230 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $644.00 | 1912252693 - ROCKWOOD CLINIC PS, ROCKWOOD EYE SURGERY CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25259 | $406.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | 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 25259 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25259 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 25259 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 |
|---|---|---|
| 25215-CPT | Moderate | Carpectomy; All Bonesor Proximal Row |
| 25251-CPT | High | Removal Wrist Prosthesis;Complicated,Tot |
| 25259-CPT | Moderate | Manipulation, Wrist, Under Anesthesia |
| 25265-CPT | High | Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Secondary, With Free Graft (Includes Obtaining Graft), Each Tendon Or Muscle |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25259 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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