CPT 27792 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 | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27792 |
| Medicaid Fee Schedule | View Medicaid rates for 27792 |
National average reimbursement for CPT 27792 by major payers:
$883.52
$880.85
$938.44
$1,068.12
CPT 27792 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27792 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 27792 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 |
|---|---|---|
| 27766-CPT | Moderate | Surgery To Repair Broken Ankle, Surgery To Repair A Broken Ankle Bone (Malleolus). Pins Wires Or Screws May Be Used To Hold The Bone In Place. |
| 27784-CPT | Moderate | Surgical Repair Of Broken Leg, Surgery To Repair A Broken Leg Bone (Fibula). Pins Wires Or Screws May Be Used To Hold The Bone Together. |
| 27788-CPT | Moderate | Treatment Of A Broken Ankle, Treatment Of A Broken Ankle (Lateral Malleolus On Outer Side Of Ankle). A Cast Or Brace Is Applied. The Bone May Be Manually Moved Into Proper Alignment. |
| 27792-CPT | Moderate | Surgery To Repair Broken Ankle, Surgery To Repair A Broken Bone On The Outer Side Of The Ankle (Malleolus). Pins Wires Or Screws May Be Used To Hold The Bone In Place. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27792. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27792 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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