CPT 27540 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 | • 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 | High |
National average reimbursement for CPT 27540 by major payers:
$1,083.72
$1,118.28
$1,164.01
$1,383.69
| 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 27540 | ||||||
United | 27540 | $3200.00 | 1316603699 - HEATHROW SURGERY CENTER LLC | 851780627 - (FL) HEATHROW SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2200.00 | 1992788772 - EAST JEFFERSON AMBULATORY SURGERY CENTER | 201425074 - (LA) EAST JEFFERSON AMBULATORY | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $4704.00 | 1043708019 - OAK POINT SURGICAL SUITES LLC | 823437812 - (TX) OAK POINT SURGICAL SUITES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2000.00 | 1770599136 - RADIANCE-A PRIVATE OUTPATIENT SURGERY CENTER LLC, RADIANCE SURGERY CENTER | 510465402 - (PA) RADIANCE, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2209.00 | 1053353359 - VISION SURGERY & LASER CENTER, LLC | 931308251 - (OR) VISION SURGERY LASER CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $1546.00 | 1295240133 - BRAINARD SURGERY CENTER LLC | 823600153 - (OH) BRAINARD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $383.00 | 1467635581 - PREMIER ENDOSCOPY CENTER,LLC | 205055187 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $13689.00 | 1114168309 - MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST, LLC | 261394069 - (CA) MEMORIAL CARE SURGICAL CENTER AT ORANGE COAST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $709.00 | 1366710741 - THE EYE PHYSICIANS OF PINELLAS, PA, LARGO AMBULATORY SURGERY CENTER | 593400241 - (FL) THE EYE PHYSICIANS OF PINELLAS, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $1400.00 | 1093295545 - SURGERY CENTER 121 LLC | 831195079 - (TX) SURGERY CENTER 121 LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2800.00 | 1679804355 - LONESTAR AMBULATORY SURGICAL CENTER | 263806076 - (TX) LONESTAR AMBULATORY SURGICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2000.00 | 1811125149 - KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | 262437385 - (TN) KNOXVILLE ORTHOPAEDIC SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2933.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $2174.00 | 1265609945 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27540 | $635.00 | 1588991228 - THE EYE SURGICAL CENTER OF FORT WAYNE, LLC | 271316595 - (IN) THE EYE SURGICAL CENTER OF FORT WAYNE LLC | IN | 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 27540 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27540 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 27540 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 |
|---|---|---|
| 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 |
| 27556-CPT | High | Open Treatment Of Knee Dislocation, Includes Internal Fixation, When Performed; Without Primary Ligamentous Repair Or Augmentation/Reconstruction |
| 27557-CPT | High | Open Tx Knee Disloc W/Wo Fix W/Rep |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27540 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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