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See a sample rate comparisonCPT 27538 Fee Schedule
Last Verified: October 2026
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.
Closed Treatment Of Intercondy, Closed Treatment Of Intercondylar Spine(S) Andor Tuberosityfracture(S) Of Knee With Or Without Manipulation Closed Treatment Of Intercondylar Spine(S) Andor Tuberosity
| 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 |
| Medicare Fee Schedule | View Medicare rates for 27538 |
| Medicaid Fee Schedule | View Medicaid rates for 27538 |
National average reimbursement for CPT 27538 by major payers:
$624.90
$632.47
$656.26
$738.58
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CPT 27538
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Bay Area Endoscopy Center, LLC, Bay Area Endoscopy
$1,831.00Published rateRiverside Park Surgicenter LLC
$555.00Published rateNorthwest Kansas Surgery Center, LLC
Northwest Kansas Surgery Center LLC
$163.00Published ratePuget Sound Gastroenterology, PLLC, Edmonds Endoscopy Center
Puget Sound Gastroenterology, P.S.
$140.00Published rateEye Surgicenter LLC
$42.00Published rate
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See a sample payer proposalCPT 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 Treatment Of Tibial Fract, Open Treatment Of Tibial Fracture Proximal (Plateau)Bicondylar With Or Without Internal Fixation Open Treatment Of Tibial Fracture Proximal (Plat Eau) |
| 27538-CPT | Moderate | Closed Treatment Of Intercondy, Closed Treatment Of Intercondylar Spine(S) Andor Tuberosityfracture(S) Of Knee With Or Without Manipulation Closed Treatment Of Intercondylar Spine(S) Andor Tuberosity |
| 27540-CPT | High | Open Treatment Of Intercondyla, Open Treatment Of Intercondylar Spine(S) Andor Tuberosity Fracture(S) Of The Knee Includes Internal Fixation When Performed |
| 27552-CPT | Moderate | Closed Treatment Of Knee Dislo, Closed Treatment Of Knee Dislocation Requiring Anesthesiaclosed Treatment Of Knee Dislocation Requiring 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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