CPT 27054 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 27054 by major payers:
$878.00
$925.54
$951.32
$1,158.86
| 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 27054 | ||||||
United | 27054 | $1880.00 | 1104087089 - CONGRESS MEDICAL SURGERY CENTER LLC | 262785454 - (CA) CONGRESS MEDICAL SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $747.00 | 1912388026 - SURGICAL CENTER OF PEAK ENDOSCOPY, LLC | 473704021 - (CO) SURGICAL CENTER OF PEAK ENDOSCOPY LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $2549.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1436.00 | 1033734793 - NAPLES SUNCOAST SURGERY CENTER, LLC | 842343047 - (FL) NAPLES SUNCOAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $4277.00 | 1346468253 - FAIRVIEW MAPLE GROVE SURGERY CENTER, LLC | 208335586 - (MN) FAIRVIEW MAPLE GROVE SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3623.00 | 1760491385 - ENDOSCOPY CENTER OF NORTHERN OHIO, LLC | 341966846 - (OH) ENDOSCOPY CENTER OF NORTHERN OHIO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $744.00 | 1275178444 - KENOSHA DIGESTIVE HEALTH CENTER LLC | 842167873 - (WI) KENOSHA DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1312.00 | 1659625101 - ENDOSCOPY CENTER OF GRAND JUNCTION LLC | 461251610 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1529.00 | 1164476933 - NOVAMED SURGERY CENTER OF SAN ANTONIO LP, AMERICAN SURGERY CENTER | 204400460 - (TX) NOVAMED SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $986.00 | 1275503906 - JERVEY EYE CENTER,LLC | 582297640 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3500.00 | 1013493824 - ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, LURIE CHILDREN'S SURGERY CENTER IN NORTHBROOK | 362170833 - ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1397.00 | 1598815110 - EXECUTIVE ENDOSCOPY, INC., ENDOSCOPY CENTER OF SAN JOSE | 770583401 - (CA) EXECUTIVE ENDOSCOPY INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3415.00 | 1376536482 - BEND SURGERY CENTER LLC, BEND SURGERY CENTER | 911772048 - (OR) BEND SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $847.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1601.00 | 1174999700 - ADVANCED SURGERY CENTER OF CENTRAL IOWA, LLC | 472673565 - (IA) ADVANCED SURGERY CENTER OF CENTRAL IOWA LLC | IA | 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 27054 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27054 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 27054 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 |
|---|---|---|
| 27033-CPT | High | Arthrotomy Hip W Expl/Rem Loose/Fb |
| 27049-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Pelvis And Hip Area; Less Than 5 Cm (Revised 01/01/2014) |
| 27050-CPT | Moderate | Arthrotomy,For Bx;Sacroiliac Joint |
| 27054-CPT | Moderate | Arthrotomy For Synovectomy,Hip Joint |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27054. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27054 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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