CPT 27256 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • 50 - Bilateral Procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27256 |
National average reimbursement for CPT 27256 by major payers:
$404.10
$406.80
$424.44
$517.86
| 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 27256 | ||||||
United | 27256 | $245.13 | 1003974270 - VALERIE TURPEN | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 27256 | $67.00 | 1760074207 - INTEGRIS DDSI ENDOSCOPY CENTERS LLC | 854253589 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $533.53 | 1154526739 - JESSICA MENDEL | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 27256 | $250.00 | 1457460248 - OSC LLC, OMAHA SURGICAL CENER | 470693440 - (NE) OSC LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $555.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $83.00 | 1255311635 - MELBOURNE ASC LP, THE SURGERY CENTER OF MELBOURNE | 621625311 - (FL) MELBOURNE ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $200.00 | 1356798854 - MID CITIES ASC, LP | 811663790 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $230.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $344.00 | 1528000817 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $267.00 | 1851531248 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $1500.00 | 1386624815 - QUALITY SURGICENTER LLC | 421480973 - (IA) QUALITY SURGICENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $400.00 | 1437202967 - REGIONAL EYE SURGERY CENTER, LLC | 208242380 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $574.00 | 1740260926 - STARK AMBULATORY SURGERY CENTER, LLC | 611448511 - (OH) STARK AMBULATORY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $318.00 | 1295233658 - LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC | 823717201 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27256 | $138.00 | 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 | 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 27256 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27256 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 27256 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 |
|---|---|---|
| 27250-CPT | Moderate | Clo Tx Hip Disloc Traum Wo Anes |
| 27253-CPT | High | Open Tx Hip Disloc Traum Wo Int Fix |
| 27254-CPT | High | Open Treatment Of Hip Dislocation, Traumatic, With Acetabular Wall And Femoral Head Fracture, With Or Without Internal Or External Fixation |
| 27256-CPT | Moderate | Treatment Of Spontaneous Hip Dislocation (Developmental, Including Congenital Or Pathological), By Abduction, Splint Or Traction; Without Anesthesia, Without Manipulation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27256. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27256 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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