CPT 25805 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25805 |
National average reimbursement for CPT 25805 by major payers:
$1,147.46
$1,151.80
$1,162.27
$1,433.81
| 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 25805 | ||||||
United | 25805 | $1562.00 | 1225050347 - STATE HILL SURGICENTER LLC | 203106650 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $4580.00 | 1568840528 - ALPHARETTA SURGERY CENTER LLC | 208459286 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $2625.00 | 1093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC | 371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $3300.00 | 1265964050 - SCHAUMBURG SURGERY CENTER, LLC | 813061805 - (IL) SCHAUMBURG SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $812.07 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $6588.00 | 1629508387 - WELLINGTON ENDOSCOPY CENTER LLC | 813254698 - (FL) WELLINGTON ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $6365.00 | 1821342858 - SURGCENTER OF ORANGE PARK, LLC, ORANGE PARK ENDOSCOPY CENTER | 460858710 - (FL) SURGCENTER OF ORANGE PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $900.00 | 1003273129 - GREAT LAKES SURGERY CENTER LLC | 465665524 - (MI) GREAT LAKES SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $6492.00 | 1811001860 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $6087.00 | 1972092146 - SURGERY CENTRE OF SW FLORIDA LLC, FORT MYERS SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $4356.00 | 1225091630 - GRAMERCY SURGERY CENTER, LTD | 752399524 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $8818.00 | 1134663677 - CASTLE HILLS SURGICARE, LLC | 813020487 - (TX) CASTLE HILLS SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $4090.00 | 1780959007 - COLUMBIA RIVER SURGERY CENTER LLC | 452481484 - (OR) COLUMBIA RIVER SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $1203.00 | 1578525283 - PRINCETON ENDOSCOPY CENTER LLC | 200445094 - (NJ) PRINCETON ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25805 | $833.00 | 1225070527 - LIBERTY CATARACT CENTER LLC | 743099283 - (MO) LIBERTY CATARACT CENTER LLC | MO | 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 25805 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25805 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 25805 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 |
|---|---|---|
| 25800-CPT | Moderate | Arthrodesis, Wrist; Complete, Without Bone Graft (Includes Radiocarpal And/Or Intercarpal And/Or Carpometacarpal Joints) |
| 25805-CPT | High | Arthrodesis, Wrist Joint; With Sliding G |
| 25810-CPT | High | Arthrodesis, Wrist Joint (Including Radiocarpal And/Or Ulnocarpal Fusion); With Iliac Or Other Autograft (Includes Ob |
| 25820-CPT | Moderate | Fusion Intercarpal Wo Bone Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25805 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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