CPT 25320 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 25320 by major payers:
$1,352.82
$1,311.22
$1,413.16
$1,652.26
| 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 25320 | ||||||
United | 25320 | $2200.00 | 1376161117 - ACCESS CARE PHYSICIANS OF NJ LLC | 203639484 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $3400.00 | 1922625995 - NATIONAL SURGICAL CENTERS STOCKTON, LLC | 842979070 - (CA) NATIONAL SURGICAL CENTERS STOCKT | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $1425.00 | 1760594279 - FILUTOWSKI EYE INSTITUTE PA, SUNRISE SURGICAL CENTER | 593111497 - (FL) FILUTOWSKI EYE INSTITUTE, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $1780.00 | 1407873292 - SURGERY CENTER OF VOLUSIA, LLC, SURGERY CENTER OF VOLUSIA | 593754620 - (FL) SURGERY CENTER OF VOLUSIA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $2850.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $1195.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $2530.00 | 1124283510 - WILLS EYE SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $2365.00 | 1336562156 - RYE SURGICAL CENTER, LLC | 463464240 - (NH) RYE SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $1700.00 | 1558580910 - ORANGE CITY SURGICAL LLC, ADVENTHEALTH SURGERY CENTER BLUE SPRINGS | 208105013 - (FL) ORANGE CITY SURGICAL, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $3067.00 | 1720011042 - PREMIER ORTHOPAEDIC SURGERY CENTER, LLC | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $2706.00 | 1558612762 - QUEENS BOULEVARD ASC LLC | 274614930 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $1325.00 | 1316970916 - SURGICAL SPECIALTY CENTER, LLC | 721418824 - (LA) SURGICAL SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $3690.00 | 1790876431 - MAIN LINE SPINE SURGERY CENTER, LLC | 202547795 - (PA) MAIN LINE SPINE SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $2552.00 | 1649921065 - JOINT REPLACEMENT CENTER OF LOUISIANA | 874022126 - (LA) JOINT REPLACEMENT CENTER OF LOUS | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25320 | $5433.00 | 1851950281 - YUMA ADVANCED SURGICAL SUITES LLC | 833076801 - (AZ) YUMA ADVANCED SURGICAL SUITES, 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 25320 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25320 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 25320 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 |
|---|---|---|
| 25312-CPT | Moderate | Tendon Transplantation Or Transfer, Flexor Or Extensor, Forearm And/Or Wrist, Single; With Tendon Graft(S) (Includes Obtaining Graft), Each Tendon |
| 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25320 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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