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See a sample rate comparisonCPT 25491 Fee Schedule
Last Verified: October 2026
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.
Secure Bone To Prevent Break, Treatment To Prevent A Break In One Or Both Bones Of The Lower Arm (Radius Or Ulna). The Bone Is Stabilized With Pins Plates Nails Or Wire.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25491 |
| Medicaid Fee Schedule | View Medicaid rates for 25491 |
National average reimbursement for CPT 25491 by major payers:
$1,045.84
$1,046.25
$1,031.85
$1,249.91
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CPT 25491
5 of 25 sample ratesHigher to lower in this preview
The Endoscopy Center At St. Francis, LLC
The Endoscopy Center At St Francis LLC
$15,626.00Published rateThomas Eye Surgery Center Of Fayette
$2,900.00Published rateNew Orleans La Uptown West Bank Endoscopy Asc LLC, Mga Gastrointestinal Diagnostic And Terapeutic Center
$2,019.00Published rateMidsouth Interventional Pain Institute, LLC, Midsouth Pain Treatment Center, LLC
Midsouth Interventional Pain Institute LLC
$1,296.00Published ratePiedmont Endoscopy Center, Inc.
$518.00Published rate
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See a sample payer proposalCPT 25491 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25491 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 25491 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 |
|---|---|---|
| 25450-CPT | Moderate | Epiphyseal Arrest By Epiphysio, Epiphyseal Arrest By Epiphysiodesis Or Stapling Distalradius Or Ulna Epiphyseal Arrest By Epiphysiodesis Or Stapling Distal |
| 25455-CPT | Moderate | Epiphyseal Arrest By Epiphysio, Epiphyseal Arrest By Epiphysiodesis Or Stapling Distalradius And Ulna Epiphyseal Arrest By Epiphysiodesis Or Stapling Distal |
| 25490-CPT | High | Secure Bone To Prevent Break, Treatment To Prevent A Break In One Or Both Bones Of The Lower Arm (Radius Or Ulna). The Bone Is Stabilized With Pins Plates Nails Or Wire. |
| 25491-CPT | High | Secure Bone To Prevent Break, Treatment To Prevent A Break In One Or Both Bones Of The Lower Arm (Radius Or Ulna). The Bone Is Stabilized With Pins Plates Nails Or Wire. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25491 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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