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See a sample rate comparisonCPT 25600 Fee Schedule
CPT 25600 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Treat Fracture Radius Ulna, Closed Treatment Of Distal Radial Fracture Eg Colles Or Smith Type Or Epiphyseal Separation Includes Closed Treatment Of Fracture Of Ulnar Styloid When Performed Without Manipulation
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 23Emergency Room |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5111 - Level 1 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | P2 - Office-based; paid from the OPPS relative weight |
| Common Revenue Codes | 04500981Sign up to view all 12 |
| Medicare Fee Schedule | View Medicare rates for 25600 |
| Medicaid Fee Schedule | $307.425 median of the 8 states in the free previewView Medicaid rates for 25600 |
National average reimbursement for CPT 25600 by major payers:
$422.37
BCBS / Anthem
$423.87
UnitedHealthcare
$469.16
Aetna
$530.69
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 25600.
CPT 25600
5 of 25 sample ratesHigher to lower in this preview
Surgical Center Of South Jersey Limited Partnership
$1,708.00Published rateJason Meckler
Deaconess Hospital Inc
$573.69Published rateSurgical Eye Center Of San Antonio
$193.00Published rateTavares Surgery LLC
$97.00Published rateWestern Maryland Surgicenter LLP
$66.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 25600 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 25600. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 25600-CPT | Treat Fracture Radius Ulna, Closed Treatment Of Distal Radial Fracture Eg Colles Or Smith Type Or Epiphyseal Separation Includes Closed Treatment Of Fracture Of Ulnar Styloid When Performed Without Manipulation |
| 25605-CPT | Treat Fracture Radius Ulna, Closed Treatment Of Distal Radial Fracture Eg Colles Or Smith Type Or Epiphyseal Separation Includes Closed Treatment Of Fracture Of Ulnar Styloid When Performed With Manipulation |
| 25606-CPT | Stabilize A Broken Wrist, Immobilization Of A Broken Wrist Using Wire Inserted Through The Skin To Hold The Bone In Place. A Cast Is Applied. |
| 25607-CPT | Open Treatmn Of Distal Radial Xtra-Articular Fract Or Epiphyseal, Open Treatment Of Distal Radial Extra-Articular Fracture Or Epiphyseal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25600. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25600 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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Frequently Asked Questions
What is a CPT code?
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to report medical, surgical, and diagnostic services and procedures to entities such as physicians, health insurance companies, and accreditation organizations. These codes standardize the reporting of healthcare services.
How can I find out the cost of a medical procedure?
Finding the exact cost of a medical procedure can be complex as prices vary based on location, provider, insurance plan, and other factors. To get a specific estimate for a procedure based on a CPT code and your location, you can use specialized tools. For accurate, localized fee schedule information, you are recommended to use a service like Payerprice.
What is a fee schedule?
A fee schedule is a complete listing of fees used by health plans to pay physicians or other providers. It specifies the maximum amount that will be paid for each service, procedure, or drug. These schedules are often based on CPT codes.
Why do prices vary for the same medical procedure?
Prices for the same medical procedure can vary significantly due to several factors, including the geographic location of the provider, the specific healthcare facility (e.g., hospital vs. outpatient clinic), the provider's individual charges, the patient's insurance plan and its negotiated rates, and the complexity of the patient's case.
Where can I look up the cost of a CPT code in my area?
To find the cost of a specific CPT code in your particular location, you would typically need to access fee schedule information. For users seeking to search for CPT codes and specific locations, Payerprice offers a fee schedule lookup tool. This tool can help you find relevant pricing information tailored to your needs.
What APC is CPT 25600 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 25600 to APC 5111 (Level 1 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 25600 in an ambulatory surgery center?
CMS lists CPT 25600 with ASC payment indicator P2: Office-based; paid from the OPPS relative weight.
Which revenue codes are billed with CPT 25600?
Hospital price transparency files list CPT 25600 under these revenue codes: including 0450, 0981, 0761, 0360 and 0510. A revenue code names the hospital department or charge category for the line; it does not change what the service is.