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 |
| Medicare Fee Schedule | View Medicare rates for 27054 |
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 | $1323.00 | 1063733095 - WOLFE SURGERY CENTER, LLC | 272625124 - (IA) WOLFE SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $4691.00 | 1295213734 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP, ENDOSCOPY CENTER OF SILICON VALLEY | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1387.00 | 1811300403 - SUMMIT SURGERY CENTER | 465701676 - (CO) SUMMIT SURGERY CENTER | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $2586.00 | 1477625390 - CENTURY SURGICAL ASSOCIATES, INC | 473537670 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1493.00 | 1104822808 - AGMG ENDOSCOPY CENTER A GENERAL PARTNERSHIP | 330885760 - (CA) AGMG ENDOSCOPY CENTER A GENERAL PARTNERSHIP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $2039.00 | 1346292372 - SURGERY CENTER PARTNERS. LLC, TIMBERLAKE SURGERY CENTER | 421580803 - (MO) SURGERY CENTER PARTNERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1159.00 | 1942793823 - STARKVILLE SURGERY CENTER LLC | 465332869 - (MS) STARKVILLE SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1248.00 | 1336170596 - THE UROLOGIC SURGICAL CENTER LLC | 562354405 - (PA) THE UROLOGIC SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $7366.00 | 1134318983 - LAGUNA NIGUEL SURGERY CENTER LLC | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $1079.00 | 1689679680 - TOSC, LLC, OSC-HMHP, LLC | 10724836 - (OH) THE ORTHOPAEDIC SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3487.00 | 1053562959 - PROHEALTH ALIGNED LLC, PROHEALTH CARE MORELAND SURGERY CENTER | 263324572 - (WI) PROHEALTH ALIGNED LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3570.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $3976.00 | 1639433956 - LOWCOUNTRY AMBULATORY CENTER, LLC | 274109893 - (SC) LOWCOUNTRY AMBULATORY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27054 | $1705.00 | 1174713382 - GREENBRIER CLINIC SURGERY CENTER | 200126880 | WV | 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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