CPT 27538 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 | • 11 - Office • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 27538 by major payers:
$624.90
$632.47
$656.26
$811.06
| 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 27538 | ||||||
United | 27538 | $381.00 | 1922255413 - TWIN CITIES AMBULATORY SURGERY CENTER LP, TWIN CITIES SURGERY CENTER | 260839397 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $143.00 | 1528253523 - MESQUITE TX ENDOSCOPY ASC LLC, TEXAS GI ENDOSCOPY CENTER | 260290859 - (TX) THE MESQUITE TX ENDOSCOPY ASC, LLC D.B.A | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $394.00 | 1831530781 - SURGCENTER CHANDLER, LLC, SURGCENTER GILBERT | 461772252 - (AZ) SURGCENTER CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $150.00 | 1265401202 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S., THE ORTHOPAEDIC SURGERY CENTER | 911502837 - NORTHWEST ORTHOPAEDIC SPECIALISTS, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $200.00 | 1184784209 - AMERICAN SURGICAL CENTERS II, LLC, AMERICAN SURGICAL CENTERS | 383486345 - (MI) AMERICAN SURGICAL CENTERS II LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $304.00 | 1528021573 - SUMMIT SURGERY CENTER LP | 621777535 - (TN) SUMMIT SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $1831.00 | 1396175246 - MEMORIAL HERMANN BAY AREA ENDOSCOPY CENTER, LLC, BAY AREA ENDOSCOPY | 364773048 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $1446.00 | 1184689010 - PARK CITIES SURGERY CENTER, LLC, PARK CITIES SURGERY CENTER | 562357079 - (TX) PARK CITIES SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $125.00 | 1265657258 - EYE SURGERY CENTER OF NORTH ALABAMA, INC. | 450506013 - (AL) EYE SURGERY CENTER OF NORTH ALABAMA, INC. | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $198.00 | 1962455964 - CYPRESS SURGERY CENTER LLC | 481214301 - (KS) CYPRESS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $361.00 | 1801196050 - AGCNY EAST LLC, ENDOSCOPY CENTER OF CENTRAL NEW YORK | 270546550 - (NY) AGCNY EAST LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $150.00 | 1457674236 - CORM SURGICENTER | 260681153 - (TX) CORM SURGICENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $445.00 | 1750517561 - CANON CITY CO MULTI SPECIALTY ASC LLC, ARKANSAS VALLEY SURGERY CENTER | 264730485 - (CO) CANON CITY CO MULTI SPECIALTY ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $529.00 | 1235567264 - WENTWORTH SURGERY CENTER, LLC | 900975592 - (NH) WENTWORTH SURGERY CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27538 | $144.00 | 1598775231 - SURGERY CENTER OF COLUMBIA COUNTY, LLC, SURGERY CENTER OF COLUMBIA COUNTY | 743171980 - (GA) SURGERY CENTER OF COLUMBIA CTY | GA | 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 27538 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27538 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 27538 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 |
|---|---|---|
| 27536-CPT | High | Open Tx Tib Fx Bicondy W/Wo Fix |
| 27538-CPT | Moderate | Clo Tx Intercond Fx Knee W/Wo Manip |
| 27540-CPT | High | Open Treatment Of Intercondylar Spine(S) And/Or Tuberosity Fracture(S) Of The Knee Includes Internal Fixation When Performed |
| 27552-CPT | Moderate | Tx Closed Knee Dislocation;W Anesthesia |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27538 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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