CPT 27786 Fee Schedule
Healthcare 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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27786 |
National average reimbursement for CPT 27786 by major payers:
$404.80
$416.53
$450.31
$534.42
| 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 27786 | ||||||
United | 27786 | $76.00 | 1639365240 - SAVANNAH PAIN CENTER, LLC | 203978153 - (GA) SAVANNAH PAIN CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $200.00 | 1952776098 - BAYTOWN ASC, LP, BAYTOWN HEART & VASCULAR SURGERY CENTER | 474501044 - (TX) BAYTOWN ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $125.00 | 1093786501 - SURGERY CENTER OF EASTON LP, HEALTHSOUTH SURGERY CENTER OF EASTON, L.P. | 721349755 - (MD) SURGERY CENTER OF EASTON LP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $1446.00 | 1649793613 - BAYLOR SURGICARE AT BLUE STAR, LLC | 812931756 - (TX) BAYLOR SURGICARE AT BLUE STAR LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $153.00 | 1770603706 - BIRMINGHAM AMBULATORY SURGICAL CENTER, PLLC, TRUVISTA SURGERY CENTER | 202208179 - (MI) BIRMINGHAM AMBULATORY SURGICAL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $637.00 | 1669075495 - SAINT JOSEPH HEALTH ASC LLC | 852155230 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $2830.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $107.00 | 1780958207 - LANCASTER SURGERY CENTER, INC. | 320361416 - (OH) LANCASTER SURGERY CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $92.00 | 1811512734 - SSL ENDOSCOPY CENTER LLC, AVALA SURGERY CENTER | 843735506 - (LA) SSL ENDOSCOPY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $100.00 | 1952404550 - WEST PALM BEACH CHILDREN'S SURGERY CENTER, LLC | 650789191 - (FL) WEST PALM BEACH CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $84.00 | 1750862389 - PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC | 831536863 - (GA) PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $267.00 | 1184375545 - MEDPARK SPECIALIZED SURGERY, LLC | 863466448 - (ND) MEDPARK SPECIALIZED SURGERY LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $5213.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $328.00 | 1861089666 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC TUCSON 5TH ST | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27786 | $1109.00 | 1962505354 - PROVIDENCE HEALTH SERVICES OF WACO, PROVIDENCE HEALTH CENTER | 741109636 - (TX) ASCENSION PROVIDENCE | TX | 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 27786 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27786 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 27786 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 |
|---|---|---|
| 27780-CPT | Moderate | Clo Tx Prox Fib/Shaft Fx W/O Manip |
| 27781-CPT | Moderate | Tx Closed Proximal Fibulaor Shaft Fx;W |
| 27786-CPT | Moderate | Clo Tx Dist Fib Fx W/O Manip |
| 27808-CPT | Moderate | Closed Treatment Of Bimalleolar Ankle Fracture (Eg. Lateral And Medial Malleoli Or Lateral And Posterior Malleoli Or Medial And Posterior Malleoli); Without Manipulation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27786. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27786 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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