Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 25431 Fee Schedule
CPT 25431 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Repair Nonunion Carpal Bone, Repair Of Nonunion Of Carpal Bone Excluding Carpal Scaphoid Navicular Includes Obtaining Graft And Necessary Fixation Each Bone
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | View Medicare rates for 25431 |
| Medicaid Fee Schedule | $588.525 median of the 8 states in the free previewView Medicaid rates for 25431 |
National average reimbursement for CPT 25431 by major payers:
$1,077.97
BCBS / Anthem
$1,058.71
UnitedHealthcare
$1,082.26
Aetna
$1,286.78
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 25431.
CPT 25431
5 of 25 sample ratesHigher to lower in this preview
Parkcreek Surgery Center Lllp
$6,506.00Published rateNewport Beach Surgery Center, LLC, Newport Beach Surgery Center
Newport Beach Surgery Center LLC
$4,080.00Published rateSansum Clinic, Sansum Clinic Asc
Sansum Clinic
$2,825.00Published rateJames Fouts
Deaconess Hospital Inc
$1,371.84Published rateInterventional Rehabilitation Center, LLC
Interventional Rehabilitation Center LLC
$626.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Looking for other data?
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 25431 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 25431. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 25394-CPT | Osteoplasty, Carpal Bone, Shortening |
| 25430-CPT | Insrt Of Vasculr Pedicle Into Carpal Bone (Eg Hori Proc), Insertion Of Vascular Pedicle Into Carpal Bone (Eg Hori Procedure) |
| 25431-CPT | Repair Nonunion Carpal Bone, Repair Of Nonunion Of Carpal Bone Excluding Carpal Scaphoid Navicular Includes Obtaining Graft And Necessary Fixation Each Bone |
| 25440-CPT | Repair Nonu Scphd Carpl B1, 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 25431) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
What APC is CPT 25431 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 25431 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 25431 in an ambulatory surgery center?
CMS lists CPT 25431 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 25431?
Hospital price transparency files list CPT 25431 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.