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See a sample rate comparisonCPT 25605 Fee Schedule
CPT 25605 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 With Manipulation
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 23Emergency Room 11Office |
| Common Modifiers | 54Surgical Care Only LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5112 - Level 2 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 04500360Sign up to view all 13 |
| Medicare Fee Schedule | View Medicare rates for 25605 |
| Medicaid Fee Schedule | $501.185 median of the 8 states in the free previewView Medicaid rates for 25605 |
National average reimbursement for CPT 25605 by major payers:
$732.56
BCBS / Anthem
$739.72
UnitedHealthcare
$814.49
Aetna
$890.31
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 25605.
CPT 25605
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Southwest Ohio, LLC, The Surgery Center Of Southwest Ohio
The Surgery Center Of Southwest
$4,482.00Published rateSurgcenter Of Greater Jacksonville, LLC
Surgcenter Of Greater Jacksonville LLC
$893.00Published rateCapital Orthopaedic Surgery Center, LLC, Capital Orthopaedic Surgery Center
Capital Orthopaedic Surgery Center LLC
$612.00Published rateCobblestone Surgery Center, Inc.
Cobblestone Surgery Center Inc
$429.00Published rateLaplata Ambulatory Urological Center, L.L.C.
Laplata Ambulatory Urological Center LLC
$277.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 25605 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 25605. 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 25605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25605 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
How can I find out the cost of a medical procedure before I get it?
To find out the cost of a medical procedure before you get it, you should first contact your insurance provider to understand your coverage, deductibles, co-pays, and out-of-pocket maximums for the specific procedure. You can also ask your healthcare provider for an estimate. For more specific cost information based on CPT codes and your location, you can utilize tools like Payerprice, which offers a fee schedule lookup tool.
What is a CPT code, and why is it important for understanding medical costs?
A CPT (Current Procedural Terminology) code is a five-digit code used by medical professionals to describe medical, surgical, and diagnostic services and procedures. It's important for understanding medical costs because these codes are standardized and used for billing and insurance claims, allowing you to accurately look up the cost of specific services.
How do I know what my insurance will cover?
To determine what your insurance will cover, you should contact your insurance provider directly. Refer to your policy documents, member portal, or call the customer service number on your insurance card. They can provide details on coverage for specific services, pre-authorization requirements, deductibles, co-pays, and co-insurance.
What should I do if I receive a medical bill that seems too high?
If you receive a medical bill that seems too high, first review it carefully for any errors. Compare it to your Explanation of Benefits (EOB) from your insurance company. Contact your healthcare provider's billing department to request an itemized bill and discuss the charges. You can also negotiate the bill or inquire about payment plans. For typical costs of services, you can use tools like Payerprice to compare the billed amount to standard rates in your area.
Where can I look up the typical cost of medical services in my area?
To look up the typical cost of medical services in your area, you can use online tools designed for price transparency. Payerprice offers a fee schedule lookup tool that allows users to search with CPT codes and specific locations to find typical costs for various medical services. You can also consult with your insurance provider, as some offer their own cost estimator tools.
What APC is CPT 25605 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 25605 to APC 5112 (Level 2 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 25605 in an ambulatory surgery center?
CMS lists CPT 25605 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 25605?
Hospital price transparency files list CPT 25605 under these revenue codes: including 0450, 0360, 0981, 0761 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.