CPT 27096 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 | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27096 |
National average reimbursement for CPT 27096 by major payers:
$203.02
$236.65
$255.38
$283.53
| 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 27096 | ||||||
United | 27096 | $1096.00 | 1083912745 - RED ROCKS SURGERY CENTERS, LLC | 271095323 - (CO) RED ROCKS SURGERY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $88.00 | 1982744231 - SOUTHLAND ENDOSCOPY CENTER, SOUTHLAND ENDOSCOPY CENTER | 330607952 - (CA) SOUTHLAND ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $90.00 | 1598189342 - MEI SURGERY CENTER LLC, MICHIGAN EYE SURGERY CENTER | 461591012 - (MI) MEI SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $110.00 | 1659609311 - RIVERLAKES SURGERY CENTER LLC | 270493977 - (CA) RIVERLAKES SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $538.00 | 1538316278 - PHYSICIANS' SURGERY CENTER OF DOWNEY, LLC | 205170962 - (CA) PHYSICIANS SURGERY CENTER OF | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $566.00 | 1831489335 - HAGERSTOWN SURGERY CENTER,LLC | 274935096 - (MD) HAGERSTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $566.00 | 1730369802 - SHORELINE SURGERY CENTER LLP, CHRISTUS SPOHN-SURGICARE OF CORPUS CHRISTI | 204911604 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $124.00 | 1154554160 - CABRILLO SURGERY CENTER | 270666008 - (CA) CABRILLO SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $574.00 | 1114253093 - CRESCENT CITY SURGERY CENTER LLC | 271113561 - (IN) CRESCENT CITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $283.07 | 1588749204 - JOHN HOLEMAN | 350593390 - DEACONESS HOSPITAL INC | SC | Hospitalist Physician (208M00000X) |
United | 27096 | $116.00 | 1194744532 - MOSES CONE MEDICAL SERVICES INC., LEBAUER ENDOSCOPY CENTER | 561714318 - MOSES CONE MEDICAL SERVICES INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $50.00 | 1639618036 - PRESENCE LAKESHORE GASTROENTEROLOGY, LLC | 811750563 - (IL) PRESENCE LAKESHORE GASTROENTEROLOGY LLC DBA DES PLAINES ENDOSCOPY CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $297.00 | 1730121401 - SALEM ENDOSCOPY CENTER, LLC | 202447516 - (OR) SALEM ENDOSCOPY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $138.00 | 1326340852 - THE SURGICAL INSTITUTE OF MONROE AMBULATORY SURGERY CENTER LLC, SURGICAL INSTITUTE OF MONROE | 270843485 - (MI) SURGICAL INSTITUTE OF MONROE | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27096 | $1886.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | 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 27096 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27096 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 27096 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 |
|---|---|---|
| 27093-CPT | Moderate | Inject For Hip Arthrography Wo Ane |
| 27095-CPT | Moderate | Injection Procedure-Hip Arthrography;W A |
| 27096-CPT | Moderate | Injection Procedure For Sacroiliac Joint, Anesthetic/Steroid, With Image Guidance (Fluoroscopy Or Ct) Including Arthrography When Performed |
| 27105-CPT | High | Transfer Paraspinal Muscle To Hip W Graf |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27096. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27096 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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