CPT 27280 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 | • 50 - Bilateral Procedure • None • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27280 |
National average reimbursement for CPT 27280 by major payers:
$1,729.03
$1,678.18
$1,802.27
$2,115.36
| 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 27280 | ||||||
United | 27280 | $3530.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $8116.00 | 1417278011 - WILSHIRE SURGERY CENTER, LLC | 270616665 - (OR) WILSHIRE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $4400.00 | 1972030161 - ADVANCED VISION SURGERY CENTER LLC | 820697854 - (CO) ADVANCED VISION SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $17750.00 | 1669437109 - MARIETTA OUTPATIENT SURGERY, LTD | 752160466 - (GA) MARIETTA OUTPATIENT SURGERY LTD | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $1386.00 | 1639618036 - PRESENCE LAKESHORE GASTROENTEROLOGY, LLC | 811750563 - (IL) PRESENCE LAKESHORE GASTROENTEROLOGY LLC DBA DES PLAINES ENDOSCOPY CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $26269.00 | 1083624670 - PRESCOTT OUTPATIENT SURGICAL CENTER LLC | 860548048 - (AZ) PRESCOTT OUTPATIENT SURGICAL CENTER, LP | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $1482.00 | 1912992900 - BOISE ENDOSCOPY CENTER, LLC, DBA MERIDIAN ENDOSCOPY CENTER | 820506078 - (ID) BOISE ENDOSCOPY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $10450.00 | 1518208883 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $4012.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $8553.00 | 1699328369 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $3700.00 | 1740876671 - FRESENIUS VASCULAR CARE DAYTON ASC LLC | 852997056 - (OH) FRESENIUS VASCULAR CARE DAYTON ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $2060.00 | 1295240133 - BRAINARD SURGERY CENTER LLC | 823600153 - (OH) BRAINARD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $13552.00 | 1326286360 - NORTH CAMPUS SURGERY CENTER LLC | 352147088 - (IN) NORTH CAMPUS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $8435.00 | 1396009346 - PARAMUS ENDOSCOPY LLC, ENDOSCOPY CENTER OF BERGEN COUNTY | 453979491 - (NJ) PARAMUS ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27280 | $7910.00 | 1720752629 - BAY SURGERY CENTERS | 453365193 - (MD) BAY SURGERY CENTERS | 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 27280 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27280 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 27280 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 |
| 27258-CPT | High | Open Treatment Of Spontaneous Hip Dislocation (Developmental, Including Congenital Or Pathological), Replacement Of Femoral Head In Acetabulum (Including Tenotomy, Etc); |
| 27266-CPT | Moderate | Clo Tx Post Hip Disloc W/Anes |
| 27280-CPT | High | Arthrodesis, Sacroiliac Joint, Open, Includes Obtaining Bone Graft, Including Instrumentation, When Performed - Deny Inv/N10 > 9/10/2016 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27280 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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