CPT 27498 Fee Schedule
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.
| 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27498 |
National average reimbursement for CPT 27498 by major payers:
$858.64
$862.36
$896.55
$1,090.31
| 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 27498 | ||||||
United | 27498 | $877.00 | 1164473922 - OPHTHALMOLOGY CENTER OF BREVARD LP, ASC OF BREVARD | 621546274 - (FL) OPHTHALMOLOGY CENTER OF BREVARD LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $3500.00 | 1366444929 - EAST WEST SURGERY CENTER LP | 621797897 - (GA) EAST WEST SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $2175.00 | 1831368356 - VERMONT EYE SURGERY & LASER CENTER | 204872230 - (VT) VERMONT EYE SURGERY & LASER CENTER, LLC 401(K) PLAN | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1378.00 | 1770532194 - BROADWEST SPECIALTY SURGICAL CENTER, LLC | 710991736 - (IN) BROADWEST SPECIALTY SURGICAL 401 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $3500.00 | 1205949245 - MEMORIAL SURGERY CENTER, LLC | 201167151 - (OK) MEMORIAL SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $3880.00 | 1003847500 - WESTSIDE OUTPATIENT CENTER, LLC, PALMS WELLINGTON SURGICAL CENTER | 651078372 - (FL) WESTSIDE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $2649.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1834.00 | 1205808938 - ABILENE EYE ASC LP, ABILENE CATARACT AND REFRACTIVE SURGERY CENTER | 621678444 - (TX) ABILENE EYE ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1863.00 | 1346621893 - NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | 472128570 - (NJ) NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1855.00 | 1699711556 - ESCNC LLC, EYE SURGERY CENTER OF NORTHERN CALIFORNIA | 462800751 - (CA) ESCNC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $2920.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $2010.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1906.00 | 1154422541 - BRUNSWICK PAIN TREATMENT CENTER, LLC | 562441571 - (GA) BRUNSWICK PAIN TREATMENT CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1800.00 | 1760196984 - JACKSON HEART AND VASCULAR CENTER LLC | 870947298 - (MS) JACKSON HEART AND VASCULAR CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27498 | $1980.00 | 1194960732 - ISURGERY, LLC | 300514883 - (SD) ISURGERY LLC | SD | 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 27498 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27498 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 27498 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 |
|---|---|---|
| 27496-CPT | Moderate | Decomp Fasciot Thigh/Knee 1 Comp |
| 27497-CPT | Moderate | Decompression Fasciotomy, Thigh And/Or Knee, 1 Compartment (Flexor Or Extensor Or Adductor); With Debridement Of Nonviable Muscle And/Or Nerve |
| 27498-CPT | Moderate | Decomp Fascio Thigh/Knee Mx Comp |
| 27499-CPT | Moderate | Decomp Fascio Thigh/Knee W/Debrid |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27498. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27498 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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