CPT 25430 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 25430 |
National average reimbursement for CPT 25430 by major payers:
$974.32
$969.37
$1,001.42
$1,219.71
| 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 25430 | ||||||
United | 25430 | $1624.00 | 1821064031 - PIEDMONT DAY SURGERY CENTER INC | 541514162 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $7770.00 | 1679065759 - MEMORIAL HERMANN SURGERY CENTER BRAZORIA, LLC | 830759140 - (TX) MEMORIAL HERMANN SURGERY CENTER BRAZORIA LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $2679.00 | 1104087089 - CONGRESS MEDICAL SURGERY CENTER LLC | 262785454 - (CA) CONGRESS MEDICAL SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $5354.00 | 1962405803 - MID RIVERS AMBULATORY SURGERY CENTER LP, MID RIVERS SURGERY CENTER | 203833902 - (MO) MID RIVERS AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $550.00 | 1861660151 - HOWERTON SURGICAL CENTER, LLC | 450581270 - (TX) HOWERTON SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $1202.00 | 1609887041 - ZITELLI & BRODLAND PC, ZITELLI & BRODLAND ASF CENTRAL | 251549973 - JOHN A. ZITELLI, MD, PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $1100.00 | 1912971326 - ADVANCED SURGERY CENTER, LLC | 351991340 - (IN) ADVANCED SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $1568.00 | 1770532194 - BROADWEST SPECIALTY SURGICAL CENTER, LLC | 710991736 - (IN) BROADWEST SPECIALTY SURGICAL 401 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $4781.00 | 1174802045 - LEONARDTOWN SURGERY CENTER LLC | 452019132 - (MD) LEONARDTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $1603.00 | 1043246077 - DUTCHESS AMBULATORY SURGICAL CENTER | 141803011 - (NY) DUTCHESS AMBULATORY SURGICAL CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $2500.00 | 1578088787 - VACCO LLC | 821221738 - (OH) VACCO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $2781.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $6506.00 | 1992827992 - ATHERTON PLASTIC SURGERY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $4354.00 | 1023182086 - EAST TEXAS MEDICAL CENTER CARTHAGE, ETMC CARTHAGE | 824005981 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25430 | $3792.00 | 1518311141 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | 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 25430 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25430 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 25430 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 |
|---|---|---|
| 25394-CPT | High | Osteoplasty, Carpal Bone, Shortening |
| 25430-CPT | Moderate | Insertion Of Vascular Pedicle Into Carpal Bone (Eg, Harii Procedure) |
| 25431-CPT | High | Repair Of Nonunion Of Carpal Bone (Excluding Carpal Scaphoid (Navicular)) (Includes Obtaining Graft And Necessary Fixation), Each Bone |
| 25440-CPT | Moderate | Repair Of Nonunion, Scaphoid Carpal (Navicular) Bone, With Or Without Radial Styloidectomy (Includes Obtaining Graft And Necessary Fixation) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25430 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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