CPT 27455 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 27455 by major payers:
$1,279.82
$1,284.02
$1,335.11
$1,600.81
| 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 27455 | ||||||
United | 27455 | $4500.00 | 1437894276 - GEORGIA INTERVENTIONAL PAIN | 872711994 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $2077.00 | 1225225592 - WESTERN CAROLINA ENDOSCOPY CENTER, LLC | 562593197 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $1400.00 | 1316499452 - COLONIE ASC LLC, SPECIALTY EYE SURGERY & LASER CENTER OF THE CAPITAL REGION | 811964670 - (NY) COLONIE ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $8018.00 | 1164056974 - ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY LLC | 842016212 - (WI) ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $6492.00 | 1295176139 - LOWCOUNTRY AMBULATORY CENTER, LLC | 274109893 - (SC) LOWCOUNTRY AMBULATORY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $6588.00 | 1134613979 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $900.00 | 1104880723 - WNC EYE SURGERY CENTERS INC | 200067898 - (NC) WNC EYE SURGERY CENTERS INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $7735.00 | 1801987805 - ENDO SURGI CENTER OF OLD BRIDGE LLC | 223679920 - (NJ) ENDO-SURGI CENTER OF OLD BRIDGE, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $1957.00 | 1225042575 - PACIFIC SURGERY CENTER LLC | 931265552 - PACIFIC SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $6512.00 | 1164458634 - SAINT FRANCIS SURGERY CENTER, LLC, SAINT FRANCIS SURGERY CENTER | 61641562 - (TN) SAINT FRANCIS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $7340.00 | 1629647268 - UNITED VASCULAR OF HUNTSVILLE, LLC | 832575902 - (AL) UNITED VASCULAR OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $1305.00 | 1235117052 - ALLEGANY AMBULATORY SURGERY CENTER LLC | 522268598 - (MD) ALLEGANY AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $1342.00 | 1194718312 - CAPE COD ASC LLC | 43424805 - (MA) CAPE COD ASSOC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $2900.00 | 1427092279 - IPM SURGERY CENTERS LLC, SPINALCARE SURGICENTER | 330983021 - (CA) IPM SURGERY CENTERS, INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27455 | $5743.00 | 1285251132 - WEST BOZEMAN SURGERY CENTER, LLC, BOZEMAN OUTPATIENT SURGERY CENTER | 371912708 - (MT) WEST BOZEMAN SURGERY CENTER LLC | MT | 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 27455 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27455 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 27455 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 |
|---|---|---|
| 27455-CPT | High | Osteotomy, Proximal Tibia, Including Fibular Excision Or Osteotomy (Includes Correction Of Genu Varus (Bowleg) Or Genu Valgus (Knock-Knee)); Before Epiphyseal Closure |
| 27457-CPT | High | Osteotomy, Proximal Tibia, Including Fibular Excision Or Osteotomy (Includes Correction Of Genu Varus (Bowleg) Or Genu Valgus (Knock-Knee)); After Epiphyseal Closure |
| 27477-CPT | Moderate | Arrest Epiphyseal Tibia Fibula Prox |
| 27479-CPT | High | Epiphy.Arrest;Comb.D.Femur,Prox T/F |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27455. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27455 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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