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See a sample rate comparisonCPT 27430 Fee Schedule
Last Verified: October 2026
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.
Remove Thigh/Knee Scar Tissue, Surgery To Remove Scar Tissue Surrounding The Quadriceps Muscle And Tendon Of Thigh And To Improve Mobility Of The Knee.
| 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 | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27430 |
| Medicaid Fee Schedule | View Medicaid rates for 27430 |
National average reimbursement for CPT 27430 by major payers:
$982.56
$1,001.37
$1,024.32
$1,219.89
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CPT 27430
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$10,989.00Published rateSummit Ventures Of Santa Barbara, Lp, Summit Surgery Center
Summit Ventures Of Santa Barbara, Lp
$3,411.00Published rateSalem Surgery Center, LLC
Salem Surgery Center LLC
$2,812.00Published rateA Center For Foot And Ankle Surgery PA, The Center For Special Surgery Of Hawthorne
A Center For Foot And Ankle Su
$1,981.00Published rateBoston Ivf, Inc., The Surgery Center Of Waltham
Boston Ivf, LLC
$766.00Published rate
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See a sample payer proposalCPT 27430 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27430 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 27430 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 |
|---|---|---|
| 27385-CPT | Moderate | Suture Quadriceps Rupture Primary |
| 27386-CPT | High | Surgical Repair Of Torn Muscle, Surgery Using Stitches To Repair A Torn Muscle In The Thigh (Hamstring Or Quadriceps). The Procedure Involves A Graft Of Tendon Or Connective Tissue. |
| 27412-CPT | High | Autologous Chondrocyte Implantation, Knee |
| 27430-CPT | Moderate | Remove Thigh/Knee Scar Tissue, Surgery To Remove Scar Tissue Surrounding The Quadriceps Muscle And Tendon Of Thigh And To Improve Mobility Of The Knee. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27430 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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