CPT 27238 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 • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27238 |
National average reimbursement for CPT 27238 by major payers:
$664.51
$617.94
$647.85
$783.56
| 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 27238 | ||||||
United | 27238 | $620.00 | 1346243680 - LAWRENCE SURGERY CENTER LLC | 481212136 - (KS) LAWRENCE SURGERY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $163.00 | 1518107937 - ALICIA SURGERY CENTER LLC | 262186548 - (CA) ALICIA SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $170.00 | 1619998648 - PAIN CARE CENTER BOISE, LLC, PAIN CARE BOISE | 200197438 - (ID) PAIN CARE CENTER BOISE, L.L.C. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $3624.00 | 1730227992 - MEMORIAL AMBULATORY SURGERY CENTER, LLC | 210634562 - (NJ) VIRTUA-MEMORIAL HOSPITAL BURLINGTON COUNTY INC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $94.00 | 1154318376 - LAHAYE CENTER FOR ADVANCED EYE CARE OF LAFAYETTE, INC. | 721227426 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $531.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $120.00 | 1326340852 - THE SURGICAL INSTITUTE OF MONROE AMBULATORY SURGERY CENTER LLC, SURGICAL INSTITUTE OF MONROE | 270843485 - (MI) SURGICAL INSTITUTE OF MONROE | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $420.00 | 1467472688 - WEST CLINIC ASTC, WEST CLINIC, PC | 621526296 - THE WEST CLINIC, PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $803.80 | 1710317979 - TIMOTHY FARLEY | 350593390 - DEACONESS HOSPITAL INC | CO | Hospitalist Physician (208M00000X) |
United | 27238 | $163.00 | 1043283294 - THE HUTCHINSON OPHTHALMOLOGY ASC LLC, SURGERY CENTER OF SOUTH CENTRAL KANSAS | 621822845 - (KS) THE HUTCHINSON OPHTHALMOLOGY ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $566.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $90.00 | 1093781601 - GI DIAGNOSTIC CENTER | 421583360 - (LA) GI DIAGNOSTIC CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $1150.00 | 1598417875 - ESSENTIA HEALTH SURGERY CENTERS-DULUTH LLC, ESSENTIA HEALTH SURGERY CENTER-MILLER HILL | 874339770 - (MN) ESSENTIA HEALTH SURGERY CENTERSDULUTH LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $149.00 | 1770837866 - SPINE AND PAIN PHYSICIANS SURGERY CENTER, LLC | 454831116 - (TN) SPINE AND PAIN PHYSICIANS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27238 | $300.00 | 1679963912 - FERTILITY LAB SCIENCES OF ORANGE COUNTY, LLC | 464731184 - (CA) FERTILITY LAB SCIENCES OF ORAN | CA | 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 27238 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27238 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 27238 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 |
|---|---|---|
| 27235-CPT | High | Red Fx-Femoral Neck W In Situ Pin |
| 27236-CPT | High | Open Tx Fem Fx Int Fix/Prosth Repla |
| 27238-CPT | Moderate | Treat Fx-Inter/Pertrochanteric |
| 27240-CPT | High | Closed Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fracture; With Manipulation, With Or Without Skin Or Skeletal Traction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27238 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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