CPT 27198 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 27198 by major payers:
$416.59
$419.63
$428.73
$529.45
| 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 27198 | ||||||
United | 27198 | $72.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $290.00 | 1902877509 - CULPEPER SURGERY CENTER LLC | 541975624 - (VA) CULPEPER SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $365.00 | 1629145685 - IDAHO EYE CENTER PA, IDAHO EYE SURGICENTER | 820379995 - (ID) IDAHO EYE CENTER, P.A. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $1115.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $144.00 | 1407223019 - VALLEY OUTPATIENT SERVICES, LLC | 474866031 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $160.00 | 1669959151 - PRECISION SURGERY CENTER, LLC. | 831362479 - (TX) PRECISION SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $78.00 | 1265455463 - THE ENDOSCOPY CENTER AT BEL AIR | 470863243 - (MD) THE ENDOSCOPY CENTER AT BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $445.00 | 1346249604 - ST. MARY'S SURGICAL CENTER LLC, ST. MARY'S SURGICAL CENTER | 201685516 - (MO) ST MARYS SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $180.00 | 1265816003 - CLEARVIEW SURGERY CENTER, LLC | 474123527 - (ID) CLEARVIEW SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $531.00 | 1548203888 - NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC, THE ORTHOPEDIC SURGERY CENTER OF ARIZONA | 202684773 - (AZ) NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $506.00 | 1942264619 - METROPOLITAN MEDICAL PARTNERS LLC, SURGERY CENTER OF CHEVY CHASE | 522303928 - (MD) METROPOLITAN MEDICAL PARTNERS LL | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $501.00 | 1831240928 - NEW GULF COAST SURGERY CENTER, LLC | 646010232 - (MS) GULFPORT SURGERY CLINIC, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $261.00 | 1063531911 - NJ VEIN & COSMETIC SURGERY CENTER, PA | 223328362 - (NJ) NJ VEIN COSMETIC SURGERY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $79.00 | 1881125870 - RENAL ASSOCIATES, P.A. | 742083988 - (TX) RENAL ASSOCIATES, PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $107.00 | 1609465269 - OKLAHOMA SPINE SURGERY CENTER | 861507485 - (OK) OKLAHOMA SPINE SURGERY CENTER | OK | 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 27198 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27198 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 27198 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 |
| 27216-CPT | High | Percutaneous Skeletal Fixation Of Posterior Pelvic Bone Fracture And/Or Dislocation, For Fracture Patterns That Disrupt The Pelvic Ring, Unilateral (Includes Ipsilateral Ilium, Sacroiliac Joint And/Or Sacrum) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27198. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27198 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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