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See a sample rate comparisonCPT 27438 Fee Schedule
Medicare rates as of October 2026
CPT 27438 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Arthroplasty, Patella; W Prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22On Campus Outpatient Hospital 24Ambulatory Surgical Center |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5115 - Level 5 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600975Sign up to view all 3 |
| Medicare Fee Schedule | $781.92 national non-facility rate (2026)View Medicare rates for 27438 |
| Medicaid Fee Schedule | $645.27 median of the 8 states in the free previewView Medicaid rates for 27438 |
National average reimbursement for CPT 27438 by major payers:
$1,117.80
BCBS / Anthem
$1,136.20
UnitedHealthcare
$1,177.25
Aetna
$1,379.85
Cigna
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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 table lists codes related to 27438. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 27438-CPT | Arthroplasty, Patella; W Prosthesis |
| 27440-CPT | Arthroplasty Knee Tibial Plateau |
| 27442-CPT | 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 | 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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Frequently Asked Questions
What APC is CPT 27438 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27438 to APC 5115 (Level 5 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 27438 in an ambulatory surgery center?
CMS lists CPT 27438 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 27438?
Hospital price transparency files list CPT 27438 under these revenue codes: 0360, 0975 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.