CPT 27258 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 |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 27258 by major payers:
$1,494.41
$1,502.76
$1,570.75
$1,859.35
| 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 27258 | ||||||
United | 27258 | $1549.00 | 1265609945 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $1409.00 | 1659594307 - EYE SURGERY CENTER OF NORTHERN NEVADA, LLC | 205368967 - (NV) EYE SURGERY CENTER OF NORTHERN NEVADA LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $696.00 | 1871718270 - PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | 521842302 - (MD) PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $3347.00 | 1811433410 - OPHTHALMOLOGY SURGERY CENTER OF ORLANDO LLC, ORLANDO OPHTHALMOLOGY SURGERY CENTER | 814378043 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $2200.00 | 1003116823 - NORTHERN N.J. ENDOSCOPY CENTER, L.L.C. | 640955113 - (NJ) NORTHERN NJ ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $4521.00 | 1831360247 - SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | 261150611 - (MO) SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $3570.00 | 1154387710 - WARNER PARK SURGERY CENTER LLC, CENTER FOR ADVANCED SURGERY | 752824260 - (AZ) WARNER PARK SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $1500.00 | 1316233612 - CPMSC CARROLLTON | 274203105 - (GA) CPMSC CARROLLTON | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $10402.00 | 1356480099 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $1763.00 | 1407004534 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $2549.00 | 1770075467 - DRY CREEK SURGERY CENTER, LLC | 825264853 - (CO) DRY CREEK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $2884.00 | 1255991238 - LEE SUMMIT ASC KC LLC, BEACON SURGERY CENTER | 831077983 - (MO) LEE SUMMIT ASC KC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $6904.00 | 1033586136 - PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC, MEMORIAL HERMANN SURGERY CENTER PARK TEN | 371789833 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $2271.00 | 1538117841 - SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC, SHELBY AMBULATORY SURGERY AT THE PHYSICIANS CENTER | 203150946 - (AL) SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27258 | $3091.00 | 1881612042 - THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC | 200147862 - (GA) THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA LLC | GA | 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 27258 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27258 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 27258 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 |
| 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 |
| 27258-CPT | High | Open Treatment Of Spontaneous Hip Dislocation (Developmental, Including Congenital Or Pathological), Replacement Of Femoral Head In Acetabulum (Including Tenotomy, Etc); |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27258. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27258 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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