CPT 27197 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 | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 27197 |
National average reimbursement for CPT 27197 by major payers:
$173.37
$170.58
$177.50
$227.57
| 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 27197 | ||||||
United | 27197 | $1708.00 | 1982680492 - ROCKLAND SURGICAL PROJECT, LLC, RAMAPO VALLEY SURGICAL CENTER | 200580403 - (NJ) ROCKLAND SURGICAL PROJECT LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $567.00 | 1083613327 - BLOOMINGTON NORMAL HEALTHCARE, LLC | 371383015 - (IL) BLOOMINGTON-NORMAL HEALTHCARE, L.L.C. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $200.00 | 1053388223 - THE OCULAR SURGERY CENTER, LLC | 742462970 - (TX) THE OCULAR SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $380.00 | 1962007757 - SURGERY CENTER AT GROVE CREEK, LLC | 854085559 - (UT) SURGERY CENTER AT GROVE CREEK LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $155.00 | 1669474748 - ARC KENTUCKY LLC, DUPONT SURGERY CENTER | 621754364 - (KY) ARC KENTUCKY LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $525.00 | 1649668781 - NORTHERN ARIZONA HEALTHCARE ORTHOPEDIC SURGERY CENTER, LLC | 472572645 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $906.00 | 1891745956 - NORTH SUBURBAN SPINE CENTER LP, NORTH METRO SURGERY CENTER | 571231282 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $94.00 | 1144983990 - MOUNTAIN WEST SURGICAL CENTER, LLC | 844185465 - (NV) MOUNTAIN WEST SURGICAL CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $1096.00 | 1891745956 - NORTH SUBURBAN SPINE CENTER LP, NORTH METRO SURGERY CENTER | 571231282 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $269.00 | 1295897106 - WESTMONT SURGERY CENTER LLC, SALT CREEK SURGERY CENTER | 364419691 - WESTMONT SURGERY CENTER, LLC DBA SALT CREEK SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $555.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $339.00 | 1114291440 - PREMIER ASC LLC, PREMIER ORTHOPAEDIC SURGERY CENTER | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $90.00 | 1982637492 - TOMOKA SURGERY CENTER, LLC | 201218596 - (FL) TOMOKA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $190.00 | 1528762671 - BOULEVARD ENT SURGERY CENTER LLC | 921460644 - (TN) BOULEVARD ENT SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27197 | $200.00 | 1184784209 - AMERICAN SURGICAL CENTERS II, LLC, AMERICAN SURGICAL CENTERS | 383486345 - (MI) AMERICAN SURGICAL CENTERS II LLC | MI | 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 27197 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27197 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 27197 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 |
|---|---|---|
| 27080-CPT | Moderate | Coccygectomy Primary |
| 27197-CPT | Low | Closed Treatment Of Posterior Pelvic Ring Frac- Ture(S) Dislocation(S) Diastasis Or Subluxation Of The Ilium Sacroiliac Joint And/Or Sacrum With Or Without Anterior Pelvic Ring Fracture(S) And/Or Dislocation(S) Of The Pubic Symphysis And/ Or Superior/Inferior Rami Unilateral Or Bila- Teral; Without Manipulation |
| 27198-CPT | Moderate | Closed Treatment Of Posterior Pelvic Ring Frac- Ture(S) Dislocation(S) Diastasis Or Subluxation Of The Ilium Sacroiliac Joint And/Or Sacrum With Or Without Anterior Pelvic Ring Fracture(S) And/Or Dislocation(S) Of The Pubic Symphysis And/ Or Superior/Inferior Rami Unilateral Or Bila- Teral Without Manipulation |
| 27202-CPT | Moderate | Open Treatment Coccygeal Fracture |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27197 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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