CPT 27254 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 • 24 - Ambulatory Surgical Center • 23 - Emergency Room |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 27254 by major payers:
$1,811.01
$1,721.75
$1,717.98
$2,122.47
| 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 27254 | ||||||
United | 27254 | $3188.00 | 1952749491 - HAYMARKET SURGERY CENTER, LLC | 462874962 - (VA) HAYMARKET SURGERY CENTER | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3350.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2799.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2250.00 | 1215309653 - BANGOR EYE SURGERY, PA | 473741642 - (ME) BANGOR EYE SURGERY PA | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2266.00 | 1336209451 - SADDLE RIVER VALLEY SURGICAL CENTER LLC, SADDLE RIVER VALLEY SURGICAL CENTER LLC | 201250583 - (NJ) SADDLE RIVER VALLEY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2075.00 | 1336213099 - SAN GABRIEL AMBULATORY SURGERY CENTER, LP | 510470714 - (CA) SAN GABRIEL AMBULATORY SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2990.00 | 1568505899 - BON SECOURS SURGERY CENTER AT HARBOUR VIEW, LLC, BON SECOURS SURGERY CENTER AT HARBOUR VIEW | 208302537 - (VA) BON SECOURS SURGERY CENTER AT HARBOUR VIEW LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1273.00 | 1124559679 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER III | 814079161 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2425.00 | 1255896676 - ASCENTIST ASC MERRIAM, LLC, ASCENTIST EAR, NOSE AND THROAT INSTITUTE | 831973214 - (KS) ASCENTIST ASC MERRIAM LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2141.00 | 1144406927 - SAN ANTONIO TX ENDOSCOPY ASC LP, SAN ANTONIO GASTROENTEROLOGY ENDOSCOPY CENTER NORTH | 200075829 - (TX) SAN ANTONIO TX ENDOSCOPY ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $962.00 | 1487779435 - LAKEFOREST AMBULATORY SURGERY CENTER, DISTRICT HEIGHTS AMBULATORY SURGERY CENTER | 521944179 - (MD) LAKEFOREST AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $4339.00 | 1730369802 - SHORELINE SURGERY CENTER LLP, CHRISTUS SPOHN-SURGICARE OF CORPUS CHRISTI | 204911604 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2147.00 | 1376657890 - SURGICAL SPECIALTY SUITES, INC | 61784797 - (MD) SURGICAL SPECIALTY SUITES INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1900.00 | 1538569207 - CUTTING EDGE SURGERY CENTER, LLC | 471696819 - (CA) CUTTING EDGE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3570.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | 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 27254 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27254 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 27254 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 |
|---|---|---|
| 27227-CPT | High | Open Treatment Of Acetabular Fracture(S) Involving Anterior Or Posterior (One) Column, Or A Fracture Running Transversely Across The Acetabulum, With Internal Fixation |
| 27228-CPT | High | 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 |
| 27250-CPT | Moderate | Clo Tx Hip Disloc Traum Wo Anes |
| 27254-CPT | High | Open Treatment Of Hip Dislocation, Traumatic, With Acetabular Wall And Femoral Head Fracture, With Or Without Internal Or External Fixation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27254. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27254 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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