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 |
| Medicare Fee Schedule | View Medicare rates for 25316 |
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 | $5754.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3500.00 | 1538569207 - CUTTING EDGE SURGERY CENTER, LLC | 471696819 - (CA) CUTTING EDGE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $7803.00 | 1104006006 - PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | 205755383 - (CA) PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $905.00 | 1407820962 - WINTER HAVEN SEBRING FL OPHTHALMOLOGY ASC LLC, EYE SURGERY & LASER CENTER | 743072437 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1800.00 | 1023123296 - ASSOCIATES SURGERY CENTERS, LLC | 510492139 - (PA) ASSOCIATES SURGERY CENTERS LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $2015.00 | 1457335077 - DENVER EYE SURGERY CENTER, LLC | 840974806 - (CO) DENVER EYE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $3449.00 | 1891722609 - EYE MDS OF PUGET SOUND PLLC, NARROWS EYE SURGERY CENTER | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1216.00 | 1639142656 - GREENSBORO OPHTHALMOLOGY ASC LLC, SURGICAL EYE CENTER | 621842511 - (NC) GREENSBORO OPHTHALMOLOGY LLC, ASC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $11106.00 | 1477552768 - COURT STREET SURGERY CENTER, LP | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $8107.00 | 1346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN | 471353602 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $1943.00 | 1538635859 - SEARCY AMBULATORY SURGERY CENTER LLC | 830756271 - (AR) SEARCY AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $4100.00 | 1255397808 - JOLIET SURGERY CENTER LIMITED PARTNERSHIP, AMSURG SURGERY CENTER | 742544709 - (IL) JOLIET SURGERY CENTER LIMITED PARTNERSHIP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $1163.00 | 1538110713 - CENTER FOR DIGESTIVE HEALTH LLC | 201606438 - (MS) CENTER FOR DIGESTIVE HEALTH LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25316 | $2650.00 | 1356890172 - DIALYSIS ACCESS SERVICES, LLC | 472322456 - (MD) DIALYSIS ACCESS SERVICES LLC | MD | 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 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.
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