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See a sample rate comparisonHealthcare 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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27625 |
| Medicaid Fee Schedule | View Medicaid rates for 27625 |
National average reimbursement for CPT 27625 by major payers:

$801.35

$790.62

$813.41

$957.51
Choose a payer to see a sample of rates for CPT 27625.
Fairview Maple Grove Surgery Center LLC
Ascension Providence
David A. Hendrick Md
Ocean County Eye Associates, P.C.
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 27625 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27625 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 27625 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 |
|---|---|---|
| 27610-CPT | Moderate | Arthrotomy Ankle Including E, Arthrotomy Ankle Including Exploration Drainage Orremoval Of Foreign Body Arthrotomy Ankle Including Exploration Drainage Or |
| 27612-CPT | Moderate | Arthrotomy Posteri Capsulr Rlease Ankle W//W/O Achille, Arthrotomy Posterior Capsular Release Ankle With Or Without Achille |
| 27620-CPT | Moderate | Exploratory Surgery Of Ankle, Surgery To Explore An Ankle Joint. The Procedure May Involve Removal Of Tissue For Testing (Biopsy) Or Removal Of A Foreign Object. |
| 27625-CPT | Moderate | Remove Lining Of Ankle Joint, Exploration Of Ankle Joint. The Procedure Includes Removal Of Inflamed Joint Lining To Alleviate Pain. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27625. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27625 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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