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See a sample rate comparisonCPT 27516 Fee Schedule
Medicare rates as of October 2026
CPT 27516 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Closed Treatment Of Distal Fem, Closed Treatment Of Distal Femoral Epiphyseal Separationwithout Manipulation Closed Treatment Of Distal Femoral Epiphyseal Separation
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5111 - Level 1 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600450Sign up to view all 4 |
| Medicare Fee Schedule | $573.16 national non-facility rate (2026)View Medicare rates for 27516 |
| Medicaid Fee Schedule | $454.82 median of the 8 states in the free previewView Medicaid rates for 27516 |
National average reimbursement for CPT 27516 by major payers:
$688.30
BCBS / Anthem
$677.09
UnitedHealthcare
$703.98
Aetna
$793.05
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 27516.
CPT 27516
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Memorial City LLC, Memorial Hermann Memorial Village Surgery Center
$1,831.00Published rateA Center For Foot And Ankle Surgery PA, The Center For Special Surgery Of Hawthorne
A Center For Foot And Ankle Su
$857.00Published rateMile High Surgicenter, LLC
$395.00Published rateWestmont Surgery Center LLC, Salt Creek Surgery Center
Westmont Surgery Center, LLC Dba Salt Creek Surgery Center
$244.00Published rateTaylor Surgery Center, LLC, Surgical Arts Surgery Center
Taylor Surgery Center LLC
$45.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 27516 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 27516. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 27510-CPT | Closed Treatment Of Femoral Fr, Closed Treatment Of Femoral Fracture Distal End Medial Or Lateral Condyle With Manipulation Closed Treatment Of Femoral Fracture Distal End Medial Or |
| 27511-CPT | Open Treatment Of Femoral Supr, Open Treatment Of Femoral Supracondylar Or Transcondylar Fracture Without Intercondylar Extension Includes Internal Fixation When Performed |
| 27516-CPT | Closed Treatment Of Distal Fem, Closed Treatment Of Distal Femoral Epiphyseal Separationwithout Manipulation Closed Treatment Of Distal Femoral Epiphyseal Separation |
| 27519-CPT | Surgery To Repair Broken Knee, Surgery To Repair Broken Knee Bones (Femoral Epiphyseal Separation). Pins Wires Or Screws May Be Used To Hold The Bones In Place. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27516 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 27516 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27516 to APC 5111 (Level 1 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 27516 in an ambulatory surgery center?
CMS lists CPT 27516 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 27516?
Hospital price transparency files list CPT 27516 under these revenue codes: 0360, 0450, 0361 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.