CPT 27416 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 27416 by major payers:
$1,241.73
$1,309.05
$1,353.78
$1,645.02
| 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 27416 | ||||||
United | 27416 | $1983.00 | 1114025608 - ELLICOTT CITY AMBULATORY SURGERY CENTER, LLLP, ELLICOTT CITY AMBULATORY SURGERY CENTER | 631213860 - (MD) ELLICOTT CITY AMBULATORY SURGERY CENTER LLLP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $5354.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $3365.00 | 1922160357 - ARAPAHOE ENDOSCOPY CENTER PARTNERSHIP PLLP | 472388780 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2838.00 | 1619970472 - CYPRESS OUTPATIENT SURGICAL CENTER, INC. | 770173551 - (CA) CYPRESS OUTPATIENT SURGICAL CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $5354.00 | 1831525112 - LONGLEAF SURGERY CENTER, LLC | 462421622 - (FL) LONGLEAF SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2625.00 | 1205076593 - HEALTHCARE PARTNERS ASC-HB, LLC, TALBERT SURGICAL ASSOCIATES, LLC | 264247365 - (CA) HEALTHCARE PARTNERS ASCHB LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $3396.00 | 1316470354 - MANHATTAN SPECIALISTS CENTER LLC | 813858597 - (KS) MANHATTAN SPECIALISTS CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2500.00 | 1013522127 - SARC BY HSH ASC PINE BLUFF, LLC, SARC BY HSH ASC PINE BLUFF LLC | 850884465 - (AR) SARC BY HSH ASC PINE BLUFF LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2210.00 | 1457552846 - CHESTERFIELD SPINE CENTER, LLC, ST. LOUIS SPINE AND ORTHOPEDIC SURGERY CENTER | 205044859 - (MO) CHESTERFIELD SPINE CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $5433.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $4459.00 | 1255339628 - BISMARCK SURGICAL ASSOCIATES, LLC | 450450254 - (ND) BISMARCK SURGICAL ASSOCIATES LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2306.00 | 1669540118 - STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC, VALLEY LASER SURGERY CENTER, INC. | 203111961 - (CA) STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $7061.00 | 1487136412 - ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC, ENDOSCOPY CENTER OF SOUTH SACRAMENTO | 364904884 - (CA) ENDOSCOPY CENTER OF SOUTH SACRAMENTO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $2014.00 | 1477503175 - PALMS WEST SURGERY CENTER LTD | 201008459 - (FL) PALMS WEST SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27416 | $3100.00 | 1871926428 - CHILDREN 1ST HOUSTON SOUTH, LLC, CHILDREN 1ST DENTAL & SURGERY CENTER | 320417239 | TX | 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 27416 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27416 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 27416 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 |
|---|---|---|
| 27412-CPT | High | Autologous Chondrocyte Implantation, Knee |
| 27415-CPT | High | Implantation Of Donor Cartilage Cells Into Knee Bone, Open Procedure |
| 27416-CPT | High | Osteochondral Autograft Knee Open |
| 27422-CPT | Moderate | Reconstruction Of Dislocating Patella; With Extensor Realignment And/Or Muscle Advancement Or Release (Eg, Campbell, Goldwaite Type Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27416 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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