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See a sample rate comparisonCPT 27405 Fee Schedule
CPT 27405 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Suture Collat Ligament Knee Prim
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 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) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600960Sign up to view all 3 |
| Medicare Fee Schedule | View Medicare rates for 27405 |
| Medicaid Fee Schedule | $509.295 median of the 8 states in the free previewView Medicaid rates for 27405 |
National average reimbursement for CPT 27405 by major payers:
$887.69
BCBS / Anthem
$913.80
UnitedHealthcare
$978.81
Aetna
$1,115.91
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 27405.
CPT 27405
5 of 25 sample ratesHigher to lower in this preview
Saint Thomas Surgery Center New Salem, LLC
Saint Thomas Surgery Center New Salem LLC
$5,354.00Published rateAdvanced Endoscopy & Surgical Center LLC, Advanced Endoscopy & Surgical Center
Advanced Endoscopy Surgical Center LLC
$3,077.00Published ratePacific Gastroenterology Endoscopy Center
$2,600.00Published rateWaterfront Surgery Center LLC
Waterfront Surgery Center
$1,737.00Published rateCataract & Laser Center, Inc.
The Cataract And Laser Center, I
$695.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27405 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 27405. 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. |
| 27405-CPT | Suture Collat Ligament Knee Prim |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27405 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 27405 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27405 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 27405 in an ambulatory surgery center?
CMS lists CPT 27405 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 27405?
Hospital price transparency files list CPT 27405 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.