Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 27613 Fee Schedule
Medicare rates as of October 2026
CPT 27613 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 99Other POS |
| Common Modifiers | 51Multiple procedures LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5072 - Level 2 Excision/ Biopsy/ Incision and Drainage |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 03600361Sign up to view all 7 |
| Medicare Fee Schedule | $260.86 national non-facility rate (2026)View Medicare rates for 27613 |
| Medicaid Fee Schedule | $203.49 median of the 8 states in the free previewView Medicaid rates for 27613 |
National average reimbursement for CPT 27613 by major payers:
$320.15
BCBS / Anthem
$330.63
UnitedHealthcare
$331.05
Aetna
$407.87
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 27613.
CPT 27613
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, Emory Orthopaedic Surgery Center
Emory Ambulatory Surgery Center At Dunwoody LLC
$1,817.00Published rateOro Valley Surgical Suites LLC
Oro Valley Surgical Suites, LLC
$1,158.00Published rateCommonwealth Eye Clinic Inc
$541.00Published rateDeerbrook Asc LLC
$413.00Published rateCynthia Kiesel
Deaconess Hospital Inc
$202.94Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Looking for other data?
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 27613 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 27613. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 27612-CPT | Arthrotomy Posteri Capsulr Rlease Ankle W//W/O Achille, Arthrotomy Posterior Capsular Release Ankle With Or Without Achille |
| 27613-CPT | Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy). |
| 27614-CPT | Biops Sft Tissue Of Leg/Ankle Area; Deep (Subfasci Or Intramus, Biopsy Soft Tissue Of Leg Or Ankle Area; Deep (Subfascial Or Intramus |
| 27615-CPT | Radical Resection Of Tumor (Eg, Radical Resection Of Tumor (Eg Malignant Neoplasm) Soft Tissue Of Leg Or Ankle Area Less Than 5 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27613. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27613 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 27613) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
What APC is CPT 27613 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 27613 to APC 5072 (Level 2 Excision/ Biopsy/ Incision and Drainage). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 27613 in an ambulatory surgery center?
CMS lists CPT 27613 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 27613?
Hospital price transparency files list CPT 27613 under these revenue codes: including 0360, 0361, 0761, 0510 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.