CPT 25630 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 25630 by major payers:
$408.99
$403.14
$430.87
$518.82
| 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 25630 | ||||||
United | 25630 | $83.00 | 1609568922 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $550.00 | 1922559327 - PHYSICIANS WEST EL PASO SURGERY CENTER, LLC | 843452204 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $100.00 | 1659451078 - ACADEMY ORTHOPEDICS, LLC, DBA ACADEMY ORTHOPEDICS, LLC, AMBULATORY SURGICAL CENTER | 582383939 - (GA) ACADEMY ORTHOPEDICS, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $555.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $1301.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $632.00 | 1619071214 - RADS OF AMERICA, LLC, PREMIER RADIOLOGY PAIN MANAGEMENT CENTER | 200597581 - (TN) RADS OF AMERICA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $2079.00 | 1407165772 - MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC, MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY | 273520409 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $1202.00 | 1821642661 - STEAMBOAT SURGERY CENTER, LLC | 834367630 - (CO) STEAMBOAT SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $172.00 | 1063514107 - OHIO SURGERY CENTER LLC | 870566551 - (OH) OHIO SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $123.00 | 1851678981 - RIDGECREST SPECIALTY SURGERY CENTER, A PROFESSIONAL CORPORATION | 453602999 - (CA) RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $73.00 | 1952602609 - GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS, PA, WAKE FOREST ENDOSCOPY CENTER | 562189630 - (NC) GASTROENTEROLOGY AND HEPATOLOGY CONSULTANTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $2499.00 | 1083754352 - MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA, MERCY PHILADELPHIA HOSPITAL SHORT PROCEDURE UNIT | 231352191 - (PA) MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $150.00 | 1780076885 - MURRELLS INLET ASC LLC, CAROLINA COAST SURGERY CENTER | 454450466 - (SC) MURRELLS INLET ASC, LLC DBA CAROLINA COAST SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $2357.00 | 1023070026 - TOMS RIVER SURGERY CENTER, LLC, TOMS RIVER SURGERY CENTER | 752854783 - (NJ) TOMS RIVER SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25630 | $437.00 | 1912460015 - PREMIER EYE SURGERY CENTER OF COLORADO, LLC, PREMIER EYE SURGERY CENTER | 823760640 - (CO) PREMIER EYE SURGERY CENTER OF COLORADO, LLC | CO | 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 25630 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25630 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 25630 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 |
|---|---|---|
| 25624-CPT | Moderate | Close Carpal Scaphoid W Manip |
| 25628-CPT | Moderate | Open Carpal Scaphoid W/Wo Fix |
| 25630-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); Without Manipulation, Each B |
| 25635-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); With Manipulation, Each Bone |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25630. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25630 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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