CPT 25274 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 25274 |
National average reimbursement for CPT 25274 by major payers:
$957.77
$944.99
$925.54
$1,158.84
| 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 25274 | ||||||
United | 25274 | $2292.00 | 1649296807 - SANSUM CLINIC, SANSUM CLINIC ASC | 956419205 - (CA) SANSUM CLINIC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $8259.00 | 1679998025 - SURGERY CENTER OF KENAI | 462556456 - (AK) SURGERY CENTER OF KENAI | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $2210.00 | 1063495257 - DOCTORS SURGICAL PARTNERSHIP LLC, MELBOURNE SAME DAY SURGERY | 593490279 - (FL) DOCTORS SURGICAL PARTNERSHIP LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $3250.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $2049.00 | 1760473425 - BECKLEY SURGERY CENTER, INC | 550764318 - (WV) BECKLEY SURGERY CENTER INC | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $2010.00 | 1992248512 - LUBBOCK VASCULAR ACCESS CENTER | 352344583 - (TX) LUBBOCK INTERVENTIONAL NEPHROLOGY ASSOCIATES PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $897.00 | 1639242506 - RENAL INTERVENTION CENTER, LLC | 371387622 - (IL) RENAL INTERVENTION CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $3347.00 | 1972092146 - SURGERY CENTRE OF SW FLORIDA LLC, FORT MYERS SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $1355.40 | 1831413772 - OXFORD UROCARE PLLC | 272032475 - (MS) OXFORD UROCARE PLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $737.00 | 1699748855 - MIDDLETOWN ENDOSCOPY ASC LLC, THE GI ENDOSCOPY CENTER | 621835826 - (OH) MIDDLETOWN ENDOSCOPY ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $763.00 | 1447301593 - 481 ASC PROJECT LLC, EYE MD LASER & SURGERY CENTER LLC | 943272782 - (CA) 481 ASC PROJECT LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $786.00 | 1710047188 - ARROWHEAD ENDOSCOPY AND PAIN MANAGEMENT CENTER LLC, ARROWHEAD ENDOSCOPY CENTER. | 205706445 - (AZ) ARROWHEAD ENDOSCOPY AND PAIN MAN | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $2227.00 | 1205869211 - ROANOKE SURGERY CENTER, LP | 61755240 - (VA) ROANOKE SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $1050.00 | 1437221660 - ENDOSCOPY CENTER, CAROLINA ENDOSCOPY CENTER- UNIVERSITY | 260317003 - (NC) ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25274 | $1220.00 | 1548223654 - SPARTAN HEALTH SURGICENTER LLC | 251898641 - (PA) SPARTAN HEALTH SURGICENTER, LLC | PA | 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 25274 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25274 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 25274 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 25274. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25274 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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