CPT 25316 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 | • 22 - On Campus Outpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 25316 by major payers:
$1,269.00
$1,275.66
$1,255.29
$1,566.96
| 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 25316 | ||||||
United | 25316 | $6020.00 | 1588656508 - SAINT THOMAS CAMPUS SURGICARE LP | 752959131 - (TN) SAINT THOMAS CAMPUS SURGICARE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3474.00 | 1588962831 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $2685.00 | 1932438553 - MIDDLESEX CENTER FOR ADVANCED ORTHOPEDIC SURGERY | 263528303 - (CT) MIDDLESEX CENTER FOR ADVANCED ORTHOPEDIC SURGERY | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1976.00 | 1780727636 - UNION SURGERY CENTER, INC, ADVANCED ENDOSCOPY CENTER | 205205858 - (CA) UNION SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $4100.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1259.00 | 1326176215 - ENDOSCOPY CENTER OF ST THOMAS LLC, NGS ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3200.00 | 1568814010 - SURGERY CENTER OF CALIFORNIA -LLC | 812978830 - (CA) SURGERY CENTER OF CALIFORNIA LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1450.00 | 1992741300 - LINCOLN ENDOSCOPY CENTER, LLC | 470807741 - (NE) LINCOLN ENDOSCOPY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1236.00 | 1679570774 - NOVAMED SURGERY CENTER OF MADISON, LIMITED PARTNERSHIP | 201915800 - (WI) NOVAMED SURGERY CENTER OF MADISON LIMITED PARTNERSHIP | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3109.00 | 1093352908 - BAPTIST HEALTHCARE SYSTEM, INC., BAPTIST HEALTH SURGERY CENTER EASTPOINT | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $4170.00 | 1184752305 - SEASHORE SURGICAL INSTITUTE, LLC | 223660141 - (NJ) SEASHORE SURGICAL INSTITUTE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3155.00 | 1023182581 - MAYS & SCHNAPP PAIN CLINIC & REHABILITATION CENTER | 621512849 - (TN) MAYS SCHNAPP PAIN CLINIC REHABILITATION CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $4234.00 | 1043708019 - OAK POINT SURGICAL SUITES LLC | 823437812 - (TX) OAK POINT SURGICAL SUITES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3335.00 | 1750378295 - BRAINERD LAKES SURGERY CENTER L L C | 200113449 - (MN) BRAINERD LAKES SURGERY CENTER, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1177.00 | 1902863723 - OAK & MAIN SURGICENTER LLC | 223532371 - (NJ) OAK MAIN SURGICENTER LLC | NJ | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 25316 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25316 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 25316 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 |
|---|---|---|
| 25315-CPT | High | Flexor Origin Slide For Cerebral Palsy; |
| 25316-CPT | High | Reposit Flexor W Tendon Transfer |
| 25320-CPT | High | Capsulorrhaphy Or Reconstruction Wrist Open (Eg Capsulodesis Ligament Repair Tendon Trans Fer Or Graft) (Includes Synovectomy Capsulotomy And Open Reduction) For Carpal Instability (Desc Rev 1/1/03) |
| 25335-CPT | High | Centralization Wrist On Ulna-Eg,Radial C |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25316 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 25316) and we'll show you how you compare in 15 minutes or less.