CPT 27458 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 | Repair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee Joint Surgical Procedures on the Femur (Thigh Region) and Knee Joint |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27458 |
National average reimbursement for CPT 27458 by major payers:
$2,680.23
$3,350.95
$2,222.33
$N/A
| 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 27458 | ||||||
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CPT 27458 vs. Other Surgical Procedures on the Femur (Thigh Region) and Knee Joint Codes
The CPT 27458 code is part of the Repair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee Joint services used for Surgical Procedures on the Femur (Thigh Region) and Knee Joint. 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 27458 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 |
|---|---|---|
| 27458-CPT | High |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27458. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27458 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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