CPT 25272 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 |
| Medicare Fee Schedule | View Medicare rates for 25272 |
National average reimbursement for CPT 25272 by major payers:
$786.62
$796.90
$780.37
$977.01
| 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 25272 | ||||||
United | 25272 | $6530.00 | 1417922915 - FRANCONIA-SPRINGFIELD SURGERY CENTER, LLC, INOVA SURGERY CENTER @ FRANCONIA-SPRINGFIELD | 542018390 - (VA) INOVA AMBULATORY SURGICAL CENTERS | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $2842.50 | 1588308035 - BAYSTATE NEW ENGLAND ORTHOPEDIC SURGEONS ALLIANCE, LLC | 881824108 - (MA) BAYSTATE NEW ENGLAND ORTHOPEDIC SURGEONS ALLIANCE LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $6342.00 | 1093120859 - PARK HILL SURGERY CENTER, LLC | 451484375 - (TX) PARK HILL SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $967.94 | 1336138650 - WILLIAM ROBERTS | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 25272 | $2175.00 | 1831368356 - VERMONT EYE SURGERY & LASER CENTER | 204872230 - (VT) VERMONT EYE SURGERY & LASER CENTER, LLC 401(K) PLAN | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $1155.00 | 1659363844 - LASER & SURGERY CENTER OF ACADIANA | 721288671 - (LA) LASER SURGERY CENTER OF ACADIANA | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $1321.00 | 1619124401 - CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | 562059693 - (NC) CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $3500.00 | 1790252864 - TREASURE COAST ASC, LLC, TREASURE COAST CENTER FOR SURGERY | 384092821 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $890.00 | 1528032711 - COLUMBIA ENDOSCOPY CENTER, LLC | 710923725 - (MO) COLUMBIA ENDOSCOPY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $6290.00 | 1063442077 - INOVA LOUDOUN AMBULATORY SURGERY | 203523190 - (VA) INOVA LOUDOUN AMBULATORY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $1040.00 | 1093726309 - INSIGHT SURGERY & LASER CENTER, LLC | 203458868 - (OH) INSIGHT SURGERY LASER CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $1706.00 | 1649961640 - USA BALDWIN COUNTY ASC, LLC, BALDWIN COUNTY SURGERY CENTER | 844335937 - (AL) USA BALDWIN COUNTY ASC LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $1151.00 | 1386792588 - WM DARRELL GASKINS LLC, NAPLES PREMIER SURGERY CENTER | 592484735 - (FL) WILLIAM DARRELL GASKINS, M.D. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $544.00 | 1548254402 - LIVE OAK ENDOSCOPY CENTER, LLC | 10709517 - (FL) LIVE OAK ENDOSCOPY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25272 | $2430.00 | 1629130521 - MIDWEST SURGERY CENTER, LLC, MIDWEST SURGERY CENTER- WOODBURY | 411537436 - (MN) MIDWEST SURGERY CENTER | MN | 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 25272 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25272 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 25272 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 25272. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25272 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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