CPT 25275 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 RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25275 |
| Medicaid Fee Schedule | View Medicaid rates for 25275 |
National average reimbursement for CPT 25275 by major payers:
$897.40
$902.86
$961.12
$1,105.35
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 25275 | $1512.00 | 1215307012 - BAY AREA SURGICENTER, LLC, BRANDON SURGERY CENTER | 474961128 - (FL) BAY AREA SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $2637.00 | 1437764321 - BAPTIST HEALTH SURGERY CENTER, LLC, BAPTIST HEALTH SURGERY CENTER AT PLANTATION | 650663357 - (FL) BAPTIST HEALTH SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $636.00 | 1235104738 - THE OVERLAND PARK KS ENDOSCOPY ASC LLC, ENDOSCOPIC IMAGING CENTER | 201635603 - (KS) THE OVERLAND PARK KS ENDOSCOPY ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1142.00 | 1578525853 - GASTROINTESTINAL CENTER OF HIALEAH, LLC | 650173048 - (FL) GASTROINTESTINAL CENTER OF HIALEAH LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1991.00 | 1073509733 - WEST PLAINS SURGERY CENTER LLC | 320093110 - (MO) WEST PLAINS AMBULATORY SURGERY CENT | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1890.00 | 1376228361 - SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | 923802390 - (OH) SPRINGFIELD REGIONAL OUTPATIENT SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1750.00 | 1902438112 - SURGERY CENTER OF SAN DIEGO, LLC | 833107404 - (CA) SURGERY CENTER OF SAN DIEGO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $2074.00 | 1275687873 - DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1420.00 | 1285608075 - PUEBLO CO OPHTHALMOLOGY ASC LLC, ROCKY MOUNTAIN LASER & SURGERY CENTER | 200121336 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1194.00 | 1730132853 - OUTPATIENT SURGERY CENTER, INC. | 204305130 - (AR) OUTPATIENT SURGERY CENTER INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $3124.00 | 1730571118 - MEDSTAR MEDICAL GROUP | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $2549.00 | 1770075467 - DRY CREEK SURGERY CENTER, LLC | 825264853 - (CO) DRY CREEK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $1490.00 | 1427183664 - LAGRECA EYE CLINIC, P.C., THE EYE CLINIC SURGICENTER | 320016290 - LAGRECA EYE CLINIC, PC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $2071.00 | 1992707855 - VESC LLC, ADVENTHEALTH SURGERY CENTER ORMOND BEACH | 593415079 - (FL) VESC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25275 | $3347.00 | 1790104248 - METRO SURGERY CENTER, LLC, METRO SURGERY CENTER, LP | 810587498 - (AZ) METRO SURGERY CENTER LLC | AZ | 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 25275 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25275 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 25275 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 Forearm Tendon Muscle, Repair Tendon Or Muscle Flexor Forearm And Or Wrist Primary Single Each Tendon Or Muscle |
| 25274-CPT | Moderate | Tendon Or Muscle Repair Of Arm, Surgery To Repair A Torn Tendon Or Muscle In The Lower Arm Or Wrist. When The Repair Is More Than 10 Days After An Injury (Or The First Procedure Failed To Restore Mobility) A Graft May Be Necessary To Bring The Ends Together. |
| 25275-CPT | Moderate | Tendon Or Muscle Repair Of Arm, Surgery To Repair A Torn Tendon Or Muscle In The Lower Arm Or Wrist. When The Repair Is More Than 10 Days After An Injury (Or The First Procedure Failed To Restore Mobility) A Graft May Be Necessary To Bring The Ends Together. |
| 25316-CPT | High | Revise Palsy Hand Tendon S, Flexor Origin Slide Eg For Cerebral Palsy Volkmann Contracture Forearm And Or Wrist With Tendon S Transfer |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25275 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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