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 | Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint Surgical Procedures on the Pelvis and Hip Joint |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27198 |
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 |
|---|---|---|---|---|---|---|
United | 27198 | $60.00 | 1467844068 - WEST ANNAPOLIS SURGERY CENTER, LLC | 472474153 - (MD) WEST ANNAPOLIS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $249.00 | 1437427333 - TOWER CLOCK SURGERY CENTER LLC | 453636581 - (WI) TOWER CLOCK SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $344.00 | 1104866904 - SOUTHWESTERN EYE CENTER, SOUTHWESTERN EYE SURGICENTER-SHOW LOW | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $79.00 | 1881131621 - FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC, AZURA SURGERY CENTER RENALUS PENSACOLA | 814605951 - (FL) FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $250.00 | 1457460248 - OSC LLC, OMAHA SURGICAL CENER | 470693440 - (NE) OSC LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $68.00 | 1649325713 - LIBERTY EYE SURGICAL CENTER, LIBERTY SURGICAL CENTER | 200054137 - (PA) LIBERTY EYE SURGICAL CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $570.00 | 1538245717 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $234.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $2159.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $574.00 | 1255361259 - CENTRAL JERSEY SURGERY CENTER LLC, CENTRAL JERSEY SURGERY CENTER | 582352848 - (NJ) CENTRAL JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $1301.00 | 1023420577 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $1800.00 | 1689635757 - ATLANTICARE SURGERY CENTER LLC | 223491867 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $574.00 | 1093086183 - CHANDLER ENDOSCOPY AMBULATORY SURGERY CENTER, LLC, CHANDLER ENDOSCOPY CENTER | 454307241 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27198 | $566.00 | 1477569069 - FISH POND SURGERY CENTER, LLC | 742901471 - (TX) FISH POND SURGERY CENTER LLC | TX | 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 | 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 Pelvis and Hip Joint Codes
The CPT 27198 code is part of the Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint services used for Surgical Procedures on the Pelvis and Hip Joint. 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 | Clsd Tx Pelvic Ring Fx, Closed Treatment Of Posterior Pelvic Ring Fracture 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 Bilateral Without Manipulation |
| 27198-CPT | Moderate | Clsd Tx Pelvic Ring Fx, Closed Treatment Of Posterior Pelvic Ring Fracture 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 Bilateral With Manipulation Requiring More Than Local Anesthesia Ie General Anesthesia Moderate Sedation Spinal Epidural |
| 27216-CPT | High | Treat Pelvic Ring Fracture, 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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