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See a sample rate comparisonCPT 27438 Fee Schedule
Last Verified: September 2026
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.
Arthroplasty, Patella; W Prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27438 |
| Medicaid Fee Schedule | View Medicaid rates for 27438 |
National average reimbursement for CPT 27438 by major payers:
$1,117.80
$1,136.20
$1,177.25
$1,379.85
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CPT 27438
5 of 25 sample ratesHigher to lower in this preview
Saint Luke'S North Surgery Center, LLC
Saint Lukes North Surgery Center LLC
$15,525.00Published ratePhoenix Spine Goodyear Asc, LLC, Phoenix Spine Surgery Center
Phoenix Spine Goodyear, Ltd.
$6,492.00Published rateEye And Laser Surgery Centers Of New Jersey LLC
$4,250.00Published rateLakeside Surgery LLC, Lakeside Surgery Center
Lakeside Surgery Center, LLC
$2,539.00Published rateSouth Georgia Endoscopy Center, Inc
South Georgia Endoscopy Center Inc
$967.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27438 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27438 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 27438 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 |
|---|---|---|
| 27438-CPT | High | Arthroplasty, Patella; W Prosthesis |
| 27440-CPT | High | Arthroplasty Knee Tibial Plateau |
| 27442-CPT | High | Knee Joint Replacement Surgery, Surgery To Replace The Damaged Ends Of A Knee Joint (Cartilage) With Artificial Parts Where It Joins The Leg (Femur) Bone. |
| 27486-CPT | High | Revisn Of Total Knee Arthroplst W//W/O Allogrft; 1 Comp, Revision Of Total Knee Arthroplasty With Or Without Allograft; 1 Comp |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27438. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27438 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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