CPT 27216 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 27216 by major payers:
$1,223.03
$1,262.87
$1,295.25
$1,550.04
| 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 27216 | ||||||
United | 27216 | $3623.00 | 1215548524 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $6342.00 | 1720020472 - DENTON SURGERY CENTER LLC, TEXAS HEALTH SURGERY CENTER DENTON | 470926556 - (TX) DENTON SURGERY CENTER, LLC DBA TEXAS HEALTH SURGERY CENTER DENTON | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $1248.00 | 1366496143 - VIRGINIA SURGERY CENTER, LLC, CVP SURGERY CENTER | 541922041 - (VA) VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $3500.00 | 1730151168 - HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP, HAWTHORN SURGERY CENTER | 582065044 - (IL) HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $6285.00 | 1275881179 - EAGLE HIGHLANDS SURGERY CENTER, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $2141.00 | 1063427706 - PROHEALTH AMBULATORY SURGERY CENTER INC | 113447394 - (NY) PROHEALTH AMBULATORY SURGERY CENTER INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $2080.00 | 1194271338 - CONROE ASC, LP, COLLEGE PARK HEART & VASCULAR SURGERY CENTER | 471450737 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $2499.00 | 1033400619 - SANTAN SURGERY CENTER, LLC | 272944317 - (AZ) SANTAN SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $1549.00 | 1659548329 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $5310.00 | 1780613521 - LITCHFIELD HILLS SURGERY CENTER | 562441789 - (CT) LITCHFIELD HILLS SURGERY CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $2809.00 | 1073944039 - THE POLYCLINIC, THE POLYCLINIC PLASTIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $2688.00 | 1720059421 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC, MINNESOTA EYE LASER & SURGERY CENTERS | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $3941.00 | 1902063605 - PENN PRESBYTERIAN MEDICAL CENTER SPU | 232810852 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $1900.00 | 1972232981 - SOUTHPOINT SURGERY CENTER LLC | 841989776 - (NC) SOUTHPOINT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27216 | $4245.00 | 1376164475 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, RIDGEWOOD ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | 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 27216 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27216 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 27216 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 |
|---|---|---|
| 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 |
| 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 27216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27216 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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