CPT 25270 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 25270 by major payers:
$706.20
$707.61
$724.32
$870.45
| 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 25270 | ||||||
United | 25270 | $1600.00 | 1700974995 - THE NEW JERSEY CENTER FOR EAR, NOSE AND THROAT DISORDERS, P.C. | 202822342 - (NJ) THE NEW JERSEY CENTER FOR EAR NOSE AND THROAT DISORDERS PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $1522.00 | 1861580870 - CAROLINAS PHYSICIANS NETWORK INC, ATRIUM HEALTH ENDOSCOPY CENTER KENILWORTH | 561667838 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $2010.00 | 1043361587 - CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER, INC. | 752829914 - (TX) CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $1900.00 | 1538569207 - CUTTING EDGE SURGERY CENTER, LLC | 471696819 - (CA) CUTTING EDGE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $1255.00 | 1912476367 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $1500.00 | 1396141545 - AXIS SURGERY CENTER LLC | 463623155 - (GA) AXIS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $3201.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $3161.00 | 1881804508 - FAIRFIELD SURGERY CENTER, LLC | 61555691 - (CT) FAIRFIELD SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $3976.00 | 1104082692 - OLD TESSON SURGERY CENTER, L.P., OLD TESSON SURGERY CENTER | 262876334 - (MO) OLD TESSON SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $7323.00 | 1487012480 - LAKE SPIVEY AMBULATORY SURGERY CARE, LLC, SPIVEY STATION SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $4600.00 | 1043708019 - OAK POINT SURGICAL SUITES LLC | 823437812 - (TX) OAK POINT SURGICAL SUITES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $3077.00 | 1851717383 - NYEEQASC,LLC, NORTH QUEENS SURGICAL CENTER | 275370037 - (NY) NYEEQASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $2884.00 | 1164527933 - NORTHWEST AMBULATORY SURGERY SERVICES, LLC, BELLINGHAM AMBULATORY SURGERY CENTER | 911830115 - (WA) NORTHWEST AMBULATORY SURGERY SERVICES, LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $2100.00 | 1790145480 - TWIN CITIES SURGERY CENTER | 463311193 - (MN) TWIN CITIES SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25270 | $2900.00 | 1952852345 - HUEBNER AMBULATORY SURGERY CENTER, LLC | 813360799 - (TX) HUEBNER AMBULATORY SURGERY CENTER LLC | 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 25270 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25270 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 25270 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 |
|---|---|---|
| 25270-CPT | Moderate | Repair Tendon/Muscle,Extensor;Primary,Si |
| 25272-CPT | Moderate | Rep Tendon/Muscle Extensor Second |
| 25274-CPT | Moderate | Repair, Tendon Or Muscle, Extensor, 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 25270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25270 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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