CPT 27616 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 27616 |
National average reimbursement for CPT 27616 by major payers:
$1,762.63
$1,749.45
$1,783.86
$2,134.31
| 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 27616 | ||||||
United | 27616 | $1020.00 | 1003855594 - OHIO EYE ASSOCIATES, INC., OHIO EYE ASSOCIATES EYE SURGERY & LASER CENTER | 341171920 - (OH) OHIO EYE ASSOCIATES, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2307.00 | 1649707324 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2859.00 | 1023191822 - SANTA BARBARA SURGERY CENTER LP | 371846158 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2007.00 | 1780109934 - BANNER MESA SURGERY CENTER LLC | 901182682 - (AZ) BANNER MESA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1591.00 | 1962402503 - NORTH KITSAP AMBULATORY SURGERY CENTER, LLC, PACIFIC SURGERY CENTER | 911276412 - (WA) NORTH KITSAP AMBULATORY CENTER, INC. DBA PACIFIC SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2050.00 | 1164534400 - MISSION HILLS SURGICENTER, LLC, MISSION HILLS PAIN TREATMENT CENTER | 203206715 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1746.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1000.00 | 1497117113 - FERTILITY PARTNERS OF PENNSYLVANIA SURGERY CENTER, LLC | 352551684 - (PA) FERTILITY PARTNERS OF PENNSYLVANIA SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2150.00 | 1255397808 - JOLIET SURGERY CENTER LIMITED PARTNERSHIP, AMSURG SURGERY CENTER | 742544709 - (IL) JOLIET SURGERY CENTER LIMITED PARTNERSHIP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2119.00 | 1447364682 - RIDGE VIEW ENDOSCOPY CENTER | 800688043 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1026.00 | 1043216617 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1578.00 | 1679728901 - ESSEX SPECIALIZED SURGICAL INSTITUTE LLC | 263777820 - (NJ) ESSEX SPECIALIZED SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $2179.76 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1678.00 | 1124093588 - UROLOGY SURGERY CENTER OF SAVANNAH, LLLP, UROLOGY SURGERY CENTER, LLP | 582511751 - (GA) UROLOGY SURGERY CENTER OF SAVANNAH LLLP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27616 | $1800.00 | 1689188823 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 823481913 | FL | 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 27616 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27616 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 27616 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 |
|---|---|---|
| 27613-CPT | Moderate | Biopsy,Soft Tissues--Leg/Ankle; Superfic |
| 27614-CPT | Moderate | Biopsy Soft Tissue Leg Deep |
| 27615-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Leg Or Ankle Area; Less Than 5 Cm (Revised 01/01/2014) |
| 27616-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Leg Or Ankle Area; 5 Cm Or Greater (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27616 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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