CPT 27556 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 | • LT - Left side of body • None • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27556 |
National average reimbursement for CPT 27556 by major payers:
$1,261.99
$1,225.89
$1,213.64
$1,496.26
| 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 27556 | ||||||
United | 27556 | $2200.00 | 1083606867 - NOVAMED SURGERY CENTER OF TYLER, LP, CATARACT CENTER OF EAST TEXAS | 680510003 - (TX) NOVAMED SURGERY CENTER OF TYLER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $2960.00 | 1336254770 - EYE SURGERY CENTER OF THE DESERT | 330708059 - (CA) EYE SURGERY CENTER OF THE DESERT | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $1125.00 | 1538109384 - PLASTIC SURGERY SPECIALISTS, PC | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $5249.00 | 1316947609 - AMARILLO ENDOSCOPY CENTER, LP | 752893120 - (TX) AMARILLO ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $2085.00 | 1588152920 - SPECIALTY SURGICAL CENTER, LLC | 352617906 - (MS) SPECIALTY SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $707.00 | 1164404638 - CAMPUS EYE GROUP ASC INC, SURGICENTER ANESTHESIA ASSOCIATES | 223047283 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $1668.00 | 1205853041 - EUCLID ENDOSCOPY CENTER, LP | 203197449 - (CA) EUCLID ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $4100.00 | 1730698374 - ADVANCED SURGICAL CENTER OF SUNSET HILLS LLC | 821806934 - (MO) ADVANCED SURGICAL CENTER OF SUNSET HILLS, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $4781.00 | 1245605633 - HARBOR HEIGHTS SURGERY CENTER, LLC | 473886948 - (MD) HARBOR HEIGHTS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $510.00 | 1497084982 - WAKE ENDOSCOPY CENTER, LLC | 208232362 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $3300.00 | 1043760184 - AUBURN SURGERY CENTER INC | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $2575.00 | 1598328932 - ENDO GROUP, LLC | 200248148 - (NY) ENDO GROUP LLC DBA GARDEN CITY SURGICENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $1950.00 | 1922280197 - NORTH OAK AMBULATORY SURGERY CENTER, LLC | 261479859 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $2364.00 | 1427787142 - CAPITAL SURGERY CENTER LLC | 861660213 - (LA) CAPITAL SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27556 | $1921.00 | 1881276319 - TEXARKANA PAIN SURGERY CENTER LLC | 844941902 - (AR) TEXARKANA PAIN SURGERY CENTER LLC | AR | 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 27556 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27556 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 27556 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 |
|---|---|---|
| 27550-CPT | Moderate | Clo Tx Knee Disloc Wo Anes |
| 27552-CPT | Moderate | Tx Closed Knee Dislocation;W Anesthesia |
| 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 27556. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27556 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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