CPT 27345 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 | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27345 |
| Medicaid Fee Schedule | View Medicaid rates for 27345 |
National average reimbursement for CPT 27345 by major payers:
$654.28
$650.14
$680.70
$801.42
CPT 27345 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27345 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 27345 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 |
|---|---|---|
| 27335-CPT | High | Removal Of Knee Joint Lining, Exploration Of Knee Joint. The Procedure Includes Removal Of Inflamed Joint Lining To Alleviate Pain. |
| 27340-CPT | Moderate | Excision, Prepatellar Bursa |
| 27345-CPT | Moderate | Xcision Of Synovial Cyst Of Popliteal Spac (Eg Bakers Cyst), Excision Of Synovial Cyst Of Popliteal Space (Eg Bakers Cyst) |
| 27347-CPT | Moderate | Xcision Of Lesion Of Meniscus Or Cpsul(Eg Cyst Ganglion) Knee, Excision Of Lesion Of Meniscus Or Capsule (Eg Cyst Ganglion) Knee |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27345. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27345 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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