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See a sample rate comparisonCPT 27403 Fee Schedule
Medicare rates as of October 2026
CPT 27403 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Arthrotomy With Open Meniscus Repair
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600960Sign up to view all 3 |
| Medicare Fee Schedule | $610.57 national non-facility rate (2026)View Medicare rates for 27403 |
| Medicaid Fee Schedule | $487.38 median of the 8 states in the free previewView Medicaid rates for 27403 |
National average reimbursement for CPT 27403 by major payers:
$901.31
BCBS / Anthem
$868.66
UnitedHealthcare
$914.12
Aetna
$1,062.54
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 27403.
CPT 27403
5 of 25 sample ratesHigher to lower in this preview
Indianapolis Endoscopy Center LLP
$7,825.00Published rateRiverside Ambulatory Surgery Center, LLC, The Endoscopy & Colonoscopy Center
Riverside Ambulatory Surgery Center LLC
$3,976.00Published rateMngi Endoscopy Asc Inc
$2,725.00Published rateAsc Gamma Partners Ltd, Miami Surgical Center
Asc Gamma Partners Ltd
$1,325.00Published rateEndosurg Outpatient Center LLC
$550.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27403 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 27403. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 27332-CPT | Arthrotomy W/ Xcision Of Semilunar Cartilage (Meniscectomy) Knee, Arthrotomy With Excision Of Semilunar Cartilage (Meniscectomy) Knee; |
| 27333-CPT | Arthrotomy W/ Xcision Of Semilunar Cartilage (Meniscectomy) Knee, Arthrotomy With Excision Of Semilunar Cartilage (Meniscectomy) Knee; |
| 27335-CPT | Removal Of Knee Joint Lining, Exploration Of Knee Joint. The Procedure Includes Removal Of Inflamed Joint Lining To Alleviate Pain. |
| 27403-CPT | Arthrotomy With Open Meniscus Repair |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27403. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27403 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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Frequently Asked Questions
What APC is CPT 27403 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27403 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 27403 in an ambulatory surgery center?
CMS lists CPT 27403 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 27403?
Hospital price transparency files list CPT 27403 under these revenue codes: 0360, 0960 and 0975. A revenue code names the hospital department or charge category for the line; it does not change what the service is.