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See a sample rate comparisonCPT 27043 Fee Schedule
Last Verified: October 2026
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.
Xcision Tumor Sft Tissue Of Pelvis & Hip Area Subcutane, Excision Tumor Soft Tissue Of Pelvis And Hip Area Subcutaneous; 3 C
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27043 |
| Medicaid Fee Schedule | View Medicaid rates for 27043 |
National average reimbursement for CPT 27043 by major payers:
$631.29
$643.96
$660.68
$782.54
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CPT 27043
5 of 25 sample ratesHigher to lower in this preview
Alpine Surgicenter, LLC
$7,011.00Published rateSummit Ambulatory Surgical Center, LLC
$2,307.00Published rateHighline South Ambulatory Surgery Center, LLC, Highline South Ambulatory Surgery Center
Highline South Ambulatory Surgery Center LLC
$1,335.00Published rateBaltimore Endoscopy Asc LLC, Gastrointestinal Diagnostic Center
Baltimore Endoscopy Asc LLC
$1,074.00Published rateWilson County Eye Surgery Center, LLC
$748.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27043 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27043 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 27043 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 |
|---|---|---|
| 27040-CPT | Moderate | Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy). |
| 27041-CPT | Moderate | Biops Sft Tissue Of Pelvis/Hip Area; Deep Subfasci Or Intram, Biopsy Soft Tissue Of Pelvis And Hip Area; Deep Subfascial Or Intram |
| 27043-CPT | Moderate | Xcision Tumor Sft Tissue Of Pelvis & Hip Area Subcutane, Excision Tumor Soft Tissue Of Pelvis And Hip Area Subcutaneous; 3 C |
| 27045-CPT | High | Exc Hip Pelv Tum Deep 5 Cm, Excision Tumor Soft Tissue Of Pelvis And Hip Area Subfascial Eg Intramuscular 5 Cm Or Greater |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27043 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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