CPT 25931 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 • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25931 |
National average reimbursement for CPT 25931 by major payers:
$1,020.71
$1,008.51
$1,038.68
$1,306.95
| 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 25931 | ||||||
United | 25931 | $3730.00 | 1366408270 - KERLAN-JOBE SURGERY CENTER LLC, HEALTHSOUTH / KERLAN-JOBE SURGERY CENTER LLC | 721349748 - (CA) KERLANJOBE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $569.00 | 1205929080 - OAK TREE SURGERY CENTER, LLC | 223524889 - (NJ) OAK TREE SURGERY CENTER, LL, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $2762.00 | 1215116611 - UPPER BAY SURGERY CENTER, LLC | 205547410 - (MD) UPPER BAY SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $2730.00 | 1992752224 - SPRINGFIELD CLINIC LLP, SPRINGFIELD CLINIC AMBULATORY SURGERY CENTER | 370701328 - (IL) SPRINGFIELD CLINIC, LLP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1083.00 | 1346215316 - CHESAPEAKE EYE SURGERY CENTER, LLC | 522310068 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1129.00 | 1841255775 - DUBUQUE ENDOSCOPY CENTER LC | 201597161 - (IA) DUBUQUE ENDOSCOPY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1919.00 | 1295233658 - LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC | 823717201 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1027.00 | 1104214261 - WEST CENTRAL SURGICAL CENTER-BAYSIDE | 472619181 - (OH) WEST CENTRAL SURGICAL CENTERBAYSIDE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $2737.00 | 1053418137 - TRI-CITY REGIONAL SURGERY CENTER LLC | 911728399 - (WA) TRI-CITY REGIONAL SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1291.30 | 1205891405 - JANINE KRAMER | 350593390 - DEACONESS HOSPITAL INC | NY | Emergency Medicine Physician (207P00000X) |
United | 25931 | $1291.30 | 1710317979 - TIMOTHY FARLEY | 350593390 - DEACONESS HOSPITAL INC | CO | Hospitalist Physician (208M00000X) |
United | 25931 | $1547.00 | 1558480947 - ISSAQUAH FOOT & ANKLE SPECIALISTS PLLC | 454029230 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $2040.00 | 1437427333 - TOWER CLOCK SURGERY CENTER LLC | 453636581 - (WI) TOWER CLOCK SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $3680.00 | 1992058325 - SOUTH BEND SPECIALTY SURGERY CENTER, LLC | 460571418 - (IN) SOUTH BEND SPECIALTY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25931 | $1202.00 | 1083796221 - SOUTHERN INDIANA SURGERY CENTER, LLC, SOUTHERN INDIANA SURGERY CENTER | 351829838 - (IN) SOUTHERN INDIANA SURGERY CENTER | IN | 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 25931 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25931 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 25931 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 |
| 25924-CPT | Moderate | Disarticulation Through Wrist;Reamputati |
| 25931-CPT | High | Reamputate Transmetacarpal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25931. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25931 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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