CPT 27130 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27130 |
National average reimbursement for CPT 27130 by major payers:
$1,758.30
$1,871.72
$1,961.59
$2,234.77
| 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 27130 | ||||||
United | 27130 | $2041.85 | 1356651301 - WILLIAM HARVIN | 760459500 - U T PHYSICIANS | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $2901.53 | 1811383524 - BRANDON DENNEY | 271789847 - SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $2447.07 | 1417978677 - PUTHENMADAM RADHAKRISHNAN | 223537011 - ADVOCARE, LLC | NJ | Pediatrics Physician (208000000X) |
United | 27130 | $3143.72 | 1710266804 - LEA THIES | 540620889 - INOVA HEALTH CARE SERVICES | VA | Family Nurse Practitioner (363LF0000X) |
United | 27130 | $1734.69 | 1174514350 - JORDAN STANLEY | 751506393 - (TX) LONGVIEW ORTHOPAEDIC CLINIC ASSOC. | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $4774.64 | 1013100098 - ALEXANDER VOLVOVSKY | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 27130 | $2309.63 | 1063466381 - DAVID JACOB | 221487330 - (NJ) SAINT PETERS UNIVERSITY HOSPITAL | NJ | Cardiovascular Disease Physician (207RC0000X) |
United | 27130 | $3290.50 | 1508864182 - THOMAS ALOST | 203059260 - BHS PHYSICIANS NETWORK, INC | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $4729.58 | 1336521582 - DANIEL BOHL | 362691111 - (IL) ROCKFORD ORTHOPEDIC ASSOCIATES, LTD. DBA ORTHOILLINOIS | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $2996.52 | 1548498736 - HAMPTON CRIMM | 540620889 - INOVA HEALTH CARE SERVICES | VA | Cardiovascular Disease Physician (207RC0000X) |
United | 27130 | $2447.07 | 1235449810 - KELLY SEVERA | 223537011 - ADVOCARE, LLC | NJ | Medical Physician Assistant (363AM0700X) |
United | 27130 | $3960.78 | 1598147969 - JULIA TOLENTINO | 202088165 - ATLANTIC HEALTH SYSTEM INC | NJ | Colon & Rectal Surgery Physician (208C00000X) |
United | 27130 | $1373.30 | 1982668695 - PLINIO CALDERA | 263639152 - (TX) UVALDE MEDICAL AND SURGICAL ASSOCIATES | TX | Orthopaedic Surgery Physician (207X00000X) |
United | 27130 | $3143.72 | 1912369497 - JASMINE HUYNH | 540620889 - INOVA HEALTH CARE SERVICES | VA | Medical Oncology Physician (207RX0202X) |
United | 27130 | $1416.67 | 1679565071 - ERICK SANTOS | 202992597 - (TX) SO. CENTRAL TX BONE & JOINT CENTER, PA | TX | Orthopaedic Surgery Physician (207X00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 27130 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27130 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 27130 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 |
|---|---|---|
| 27091-CPT | High | Removal Of Hip Prosthesis; Complicated, Including Total Hip Prosthesis, Methylmethacrylate With Or Without Insertion Of Spacer |
| 27111-CPT | High | Transfer Iliopsoas; To Femoral Neck |
| 27120-CPT | High | Acetabuloplasty (Whitman/Colonna) |
| 27130-CPT | High | Surgical Service Bundle Includes All Surgery Related Health Services Which Are Incurred In Connection With An Approved Outpatient Surgical Procedure, Billed Via The Agreed Upon Cpt Codes And Reimbursed At A Single Payment Rate Including All Services Such |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27130 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 27130) and we'll show you how you compare in 15 minutes or less.