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 |
| Medicare Fee Schedule | View Medicare rates for 27254 |
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 | $7838.00 | 1407165772 - MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY, LLC, MEMORIAL HERMANN SURGERY CENTER WOODLANDS PARKWAY | 273520409 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3623.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1675.00 | 1750456539 - WIREGRASS RANCH ASC HOLDINGS, WIREGRASS RANCH AMBULATORY SURGERY CENTER | 991010158 - (FL) WIREGRASS RANCH ASC HOLDINGS | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1276.00 | 1467153718 - WATERFRONT SURGERY CENTER LLC | 881302078 - (KS) WATERFRONT SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2647.00 | 1679235584 - ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | 872158427 - (MN) ALLINA HEALTH HEART AND VASCULAR SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1310.00 | 1902981558 - LANE SURGERY CENTER, LLC | 931305103 - (OR) LANE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3570.00 | 1669574539 - MANCHESTER SURGERY CENTER, LLC | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1424.00 | 1487655627 - UNION PINES SURGERY CENTER,LLC | 731622427 - (OK) UNION PINES SURGERY CENTER, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $1750.00 | 1437691177 - FRESENIUS VASCULAR CARE CINCINNATI ASC LLC, AZURA SURGERY CENTER CINCINNATI | 814225843 - (OH) FRESENIUS VASCULAR CARE CINCINNATI ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3952.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $2401.66 | 1437114378 - EMERALD COAST SURGERY CENTER, LP, EMERALD COAST SURGERY CENTER | 621502718 - (FL) EMERALD COAST SURGERY CENTER LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $654.00 | 1801961313 - PRINCETON EYE GROUP PA, EYE SURGERY PRINCETON | 222361560 - (NJ) PRINCETON EYE GROUP | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27254 | $3075.00 | 1225531544 - ANNE ARUNDEL-SCA SURGICENTER, LLC | 824763728 - (MD) ANNE ARUNDELSCA SURGICENTER LLC | MD | 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 | $6734.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | 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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