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See a sample rate comparisonCPT 27226 Fee Schedule
Medicare rates as of October 2026
CPT 27226 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Open Treatment Of Posterior Or, Open Treatment Of Posterior Or Anterior Acetabularwallfracture With Internal Fixation Open Treatm Ent Of Posterior Or Anterior Acetabular Wall
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $967.29 national non-facility rate (2026)View Medicare rates for 27226 |
| Medicaid Fee Schedule | $768.195 median of the 8 states in the free previewView Medicaid rates for 27226 |
National average reimbursement for CPT 27226 by major payers:
$1,393.53
BCBS / Anthem
$1,416.45
UnitedHealthcare
$1,489.91
Aetna
$1,721.89
Cigna
Compare published rates across providers.
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CPT 27226
5 of 25 sample ratesHigher to lower in this preview
Endoscopy Asc Of Middle Georgia LLC
$5,433.00Published rateEndoscopy Asc Of Middle Georgia LLC
$5,020.00Published rateMid City Specialty Center, LLC
Mid City Specialty Center LLC
$2,237.00Published rateFour States Surgery Center, PC, Four States Surgery Center,
Four States Surgery Center, PC
$1,516.00Published rateCentral Florida Eye Institute Pl
$702.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27226 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 27226. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 27226-CPT | Open Treatment Of Posterior Or, Open Treatment Of Posterior Or Anterior Acetabularwallfracture With Internal Fixation Open Treatm Ent Of Posterior Or Anterior Acetabular Wall |
| 27227-CPT | Open Treatment Of Acetabular F, Open Treatment Of Acetabular Fracture(S) Involvinganterior Or Posterior (One) Column Or A Fracture Running Transversely Across The Acetabulum With Internal Fixation |
| 27228-CPT | Treat Hip Fracture S, Open Treatment Of Acetabular Fracture S Involving Anterior And Posterior Two Columns Includes T Fracture And Both Column Fracture With Complete Articular Detachment Or Single Column Or Transverse Fracture With Associated Acetabular Wall Fracture With Internal Fixation |
| 27230-CPT | Closed Treatment Of Femoral Fr, Closed Treatment Of Femoral Fracture Proximal End Neckwithout Manipulation Closed Treatment Of Femoral Fracture Proximal End Neck |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27226 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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Frequently Asked Questions
What APC is CPT 27226 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27226 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 27226 in an ambulatory surgery center?
CMS lists CPT 27226 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 27226?
Hospital price transparency files list CPT 27226 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.