CPT 25265 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25265 |
National average reimbursement for CPT 25265 by major payers:
$1,035.39
$1,052.99
$1,037.10
$1,296.32
| 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 25265 | ||||||
United | 25265 | $643.00 | 1518922541 - VISION SURGICAL CENTER AT SPRINGHILL PSC | 352100428 - (IN) VISION SURGICAL CENTER AT SPRINGHILL PSC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $2280.00 | 1417286428 - ALLIANCE SURGICAL CENTER LLC | 271367127 - (FL) ALLIANCE SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $10552.82 | 1902920622 - WEST PENN ALLEGHENY HEALTH SYSTEM INC., ALLEGHENY GENERAL HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $1245.00 | 1679602544 - TGH SURGERY CENTER AT MORSANI, LLC, TGH SURGERY CENTER | 871193981 - (FL) TGH SURGERY CENTER AT MORSANI LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $2384.00 | 1184164816 - DELRAY BEACH SURGICAL SUITES, LLC | 813054776 - (FL) DELRAY BEACH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $3623.00 | 1326453325 - CAPITAL CITY SURGERY CENTER OF FLORIDA LLC | 471211202 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $1245.00 | 1336439645 - ACADEMIC UROLOGY OF PA, LLC | 205328092 - (PA) ACADEMIC UROLOGY OF PA, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $1685.00 | 1700437423 - JOHNS HOPKINS SURGERY CENTERS SERIES, LUTHERVILLE SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $6189.00 | 1275682148 - TEMPLE UNIVERSITY HOSPITAL, INC | 232825878 - (PA) TEMPLE UNIVERSITY HOSPITAL INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $4192.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $11871.00 | 1154454205 - TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | 751748586 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $6342.00 | 1023316197 - NORTH DALLAS SURGICAL CENTER,LLC, TEXAS HEALTH SURGERY CENTER ADDISON | 272248103 - (TX) NORTH DALLAS SURGICAL CENTERLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $3357.00 | 1639553779 - UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC., M HEALTH CLINICS AND SURGERY CENTER | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $1180.00 | 1346662186 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA PORT ST. LUCIE | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25265 | $896.00 | 1952336521 - CASC AQUISITION INC, CAROLINA AMBULATORY SURGERY CENTER | 810576467 - (SC) CASC AQUISITION INC | SC | 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 25265 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25265 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 25265 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 |
|---|---|---|
| 25260-CPT | Moderate | Repair Tendon/Muscle Flexor Primary |
| 25263-CPT | Moderate | Repair Tendon/Muscle,Flexor;2ndardy,Sing |
| 25265-CPT | High | Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Secondary, With Free Graft (Includes Obtaining Graft), Each Tendon Or Muscle |
| 25312-CPT | Moderate | Tendon Transplantation Or Transfer, Flexor Or Extensor, Forearm And/Or Wrist, Single; With Tendon Graft(S) (Includes Obtaining Graft), Each Tendon |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25265 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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