CPT 25927 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • 58 - Staged or related procedure during postoperative period • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25927 |
National average reimbursement for CPT 25927 by major payers:
$1,124.20
$1,105.15
$1,134.60
$1,420.52
| 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 25927 | ||||||
United | 25927 | $1063.00 | 1972522985 - MIDDLESEX ENDOSCOPY CENTER LLC | 20722190 - (CT) MIDDLESEX ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $6175.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $7323.00 | 1306472063 - THE EMORY CLINIC INC, EMORY ENDOSCOPY CENTER AT DECATUR | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $1530.00 | 1134140122 - ARTHROSCOPIC SURGERY CENTER, LLC | 392000854 - (WI) ARTHROSCOPIC SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $3347.00 | 1770929044 - SURGCENTER OF PALM BEACH GARDENS, SURGCENTER OF PALM BEACH GARDENS, LLC | 462315994 - (FL) SURGCENTER OF PALM BEACH GARDENS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $1683.00 | 1467844068 - WEST ANNAPOLIS SURGERY CENTER, LLC | 472474153 - (MD) WEST ANNAPOLIS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $1980.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 455323939 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $705.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $1750.00 | 1275708919 - WOMEN'S SURGICAL CENTER AT NORTHCARE, LLC | 261411936 - (CO) WOMEN S SURGICAL CENTER AT NOR | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $2175.00 | 1679531610 - BOSTON UNIVERSITY EYE ASSOCIATES, INC., BOSTON UNIVERSITY EYE ASSOCIATES SURGERY & LASER CENTER | 43137333 - (MA) BOSTON UNIVERSITY EYE ASSOCIATES INC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $747.00 | 1033292214 - PIKES PEAK ENDOSCOPY AND SURGERY CENTER, LLC | 841379009 - (CO) PIKES PEAK ENDOSCOPY AND SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $550.00 | 1235165531 - LAKE SURGERY & ENDOSCOPY CENTER LTD | 593325730 - (FL) LAKE SURGERY ENDOSCOPY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $4339.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $747.00 | 1912388026 - SURGICAL CENTER OF PEAK ENDOSCOPY, LLC | 473704021 - (CO) SURGICAL CENTER OF PEAK ENDOSCOPY LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25927 | $3570.00 | 1083176309 - SPICEWOOD SURGERY CENTER LLC, SPICEWOOD SURGERY CENTER | 834343089 - (TX) SPICEWOOD SURGERY CENTER LLC | TX | 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 25927 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25927 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 25927 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 |
|---|---|---|
| 25830-CPT | High | Arthrodesis, Distal Radioulnar Joint With Segmental Resection Of Ulna, With Or Without Bone Graft (Eg, Sauve-Kapandji Procedure) |
| 25922-CPT | Moderate | Disarticulat At Wrist 2nd Close |
| 25924-CPT | Moderate | Disarticulation Through Wrist;Reamputati |
| 25927-CPT | High | Amputate Transmetacarpal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25927. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25927 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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