CPT 27259 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 |
| Medicare Fee Schedule | View Medicare rates for 27259 |
National average reimbursement for CPT 27259 by major payers:
$1,946.97
$2,090.83
$2,131.51
$2,573.40
| 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 27259 | ||||||
United | 27259 | $1176.00 | 1710985445 - HERSHEY ENDOSCOPY CENTER, LLC | 562336622 - (PA) HERSHEY ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $597.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $1498.00 | 1770869927 - SYRACUSE SURGERY CENTER, LLC | 453629322 - (NY) SYRACUSE SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2651.00 | 1073763652 - LEBONHEUR EAST SURGERY CENTER II LP, LEBONHEUR EAST SURGERY CENTER LP | 800247391 - (TN) LEBONHEUR EAST SURGERY CENTER II LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $1820.00 | 1558339424 - PREMIER SURGERY CENTER | 352206509 - (CA) PREMIPREMIER SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2368.00 | 1942335971 - PALOS SURGICENTER, LLC | 364404305 - (IL) PALOS SURGICENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2081.00 | 1215531215 - HAUPPAUGE SC, LLC | 352651325 - (NY) HAUPPAUGE SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $1731.00 | 1447661145 - ADVANCED OUTPATIENT SURGERY OF OKLAHOMA, LLC | 371751472 - (OK) ADVANCED OUTPATIENT SURGERY OF | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2942.00 | 1366536880 - SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC | 911959910 - (WA) SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $3623.00 | 1790093813 - AZ WEST ENDOSCOPY CENTER LLC | 272343469 - (AZ) AZ WEST ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $614.00 | 1437232758 - SHADY GROVE REPRODUCTIVE SCIENCE CENTER PC, SGFC SURGERY CENTER | 208131466 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2074.00 | 1275687873 - DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2000.00 | 1659451078 - ACADEMY ORTHOPEDICS, LLC, DBA ACADEMY ORTHOPEDICS, LLC, AMBULATORY SURGICAL CENTER | 582383939 - (GA) ACADEMY ORTHOPEDICS, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $2035.00 | 1134779622 - HELIX SURGICENTER LLC | 834455797 - (IN) HELIX SURGICENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27259 | $3200.00 | 1225221435 - GALLERIA SURGERY CENTER LLC | 731713874 - (MD) GALLERIA SURGERY CENTER LLC | MD | 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 27259 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27259 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 27259 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 |
|---|---|---|
| 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 |
| 27257-CPT | Moderate | Treatment Of Spontaneous Hip Dislocation (Developmental, Including Congenital Or Pathological), By Abduction, Splint Or Traction; With Manipulation, Requiring Anesthesia |
| 27259-CPT | High | Open Treatment Of Spontaneous Hip Dislocation (Developmental, Including Congenital Or Pathological), Replacement Of Femoral Head In Acetabulum (Including Tenotomy, Etc); With Femoral Shaft Shortening |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27259 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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