CPT 25431 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25431 |
National average reimbursement for CPT 25431 by major payers:
$1,077.97
$1,058.71
$1,082.26
$1,319.72
| 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 25431 | ||||||
United | 25431 | $2450.00 | 1467016055 - HARBIN CLINIC, LLC, HARBIN CLINIC GI LAB CARTERSVILLE | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $626.00 | 1205839487 - INTERVENTIONAL REHABILITATION CENTER, LLC | 593673361 - (FL) INTERVENTIONAL REHABILITATION CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $2825.00 | 1649296807 - SANSUM CLINIC, SANSUM CLINIC ASC | 956419205 - (CA) SANSUM CLINIC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $6506.00 | 1467405837 - PARKCREEK SURGERY CENTER LLLP | 843082809 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $5732.70 | 1124612924 - MILWAUKEE SURGICENTER LLC | 854072458 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $1371.84 | 1215031851 - JAMES FOUTS | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 25431 | $3993.00 | 1326761792 - SOUTHWEST SURGICAL CENTER LLC | 412013700 - (MN) SOUTHWEST SURGICAL CENTER, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $5354.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $3424.00 | 1154326650 - SCOTTSDALE SURGICAL PARTNERS LLC, NORTH VALLEY SURGERY CENTER | 201808351 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $4080.00 | 1316949415 - NEWPORT BEACH SURGERY CENTER, LLC, NEWPORT BEACH SURGERY CENTER | 330488134 - (CA) NEWPORT BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $4365.00 | 1225221435 - GALLERIA SURGERY CENTER LLC | 731713874 - (MD) GALLERIA SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $1725.00 | 1063853174 - NATIONAL SURGICAL CENTERS OF AMERICA LLC, NSCOA THE VILLAGES | 264278807 - (FL) NATIONAL SURGICAL CENTERS OF AMERICA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $2900.00 | 1437642857 - GEORGIA VASCULAR & VEIN CENTER | 822239594 - (GA) GEORGIA VASCULAR VEIN CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $3398.00 | 1124571104 - UROLOGY SURGERY CENTER JOHNS CREEK LLC | 811521583 - (GA) UROLOGY SURGERY CENTER JOHNS CREEK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25431 | $4100.00 | 1184680407 - OAK BROOK SURGICAL CENTRE INC. | 363317971 - (IL) OAKBROOK SURGICAL CENTRE, INC | IL | 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 25431 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25431 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 25431 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 25431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25431 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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