What factors influence CPT 27814 fee schedules?

Factors affecting CPT 27814 fee schedules include Medicare & Medicaid Rates (government-set), Private Insurance Rates (negotiated between providers and insurers), Geographic Location (costs higher in urban areas), and Provider Type (hospital vs. private practice).

How can I find out the cost of a medical procedure or service before I receive it?

To get an estimate for a medical procedure or service, it's best to contact your healthcare provider's billing department directly. You can also contact your health insurance company, as they can provide an estimate of your out-of-pocket costs based on your plan's benefits. For a comprehensive tool to search for prices based on CPT code and specific location, you can use Payerprice's fee schedule lookup tool.

What is a CPT code and how does it relate to healthcare costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by medical professionals to describe medical, surgical, and diagnostic services. They are crucial for healthcare billing and help ensure that providers and payers (like insurance companies) communicate effectively about the services rendered. Each CPT code corresponds to a specific service, and its use allows for consistent pricing and reimbursement across the healthcare system.

Where can I find specific price information for medical procedures based on CPT codes and my location?

To find specific price information for medical procedures using CPT codes and your specific location, you can utilize Payerprice's fee schedule lookup tool. This tool allows users to search for prices based on the CPT code of the service and geographical area, helping you understand potential costs.

Why is it often difficult to get a clear price for healthcare services upfront?

Healthcare pricing can be complex due to several factors. Prices often vary significantly between different providers, and even within the same facility, based on factors like insurance contracts, whether the provider is in-network or out-of-network, and the specific services bundled together. Additionally, the final cost can depend on unexpected services rendered during a procedure. Federal regulations have been enacted to improve price transparency, but navigating these variations can still be challenging. Tools like Payerprice aim to simplify this process by providing searchable fee schedules.

What should I do if I have questions about my medical bill or want to dispute a charge?

If you have questions or wish to dispute a medical bill, start by contacting the healthcare provider's billing department directly. Request an itemized bill, which lists all services and charges. Review it carefully against any explanation of benefits (EOB) from your insurance company. If discrepancies persist, contact your insurance company for clarification. Many states also have consumer protection agencies or ombudsmen that can assist with billing disputes. Remember to keep detailed records of all communications.

CPT 27814 Fee Schedule

Q: What is CPT Code 27814?

CPT Code 27814 describes the 'Open Treatment Of Bimalleolar Ankle Fracture (Eg.Lateral And Medial Malleoli Or Lateral And Posterior Malleoli Or Medial And Posterior Malleoli) Includes Internal Fixation When Performed'. It is used by healthcare providers to document and receive reimbursement for high-level medical decision-making related to this surgical procedure.

Q: How does CPT 27814 compare to other musculoskeletal surgery codes?

CPT 27814 is part of the Surgery services for Surgical Procedures on the Musculoskeletal System. It represents a high-complexity encounter involving more provider time and moderate medical decision-making, typically including multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement compared to lower-level codes.

Last Verified: October 2026

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.

Treatment Of Ankle Fracture, Open Treatment Of Bimalleolar Ankle Fracture Eg Lateral And Medial Malleoli Or Lateral And Posterior Malleoli Or Medial And Posterior Malleoli Includes Internal Fixation When Performed

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 RT - Right side of body LT - Left side of body
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 27814
Medicaid Fee Schedule	View Medicaid rates for 27814

National average reimbursement for CPT 27814 by major payers:

$1,079.37

$1,046.04

$1,105.38

$1,267.21

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CPT 27814

5 of 25 sample ratesHigher to lower in this preview

Summit Orthopedics, Ltd, Plymouth Surgery Center
Summit Orthopedics, Ltd.
MNAmbulatory Surgical Clinic/CenterNPI 1497120588Tax ID 41-1762331
$8,201.00Published rate
Endoscopy Center Of Ocean County, LLC
Endoscopy Center Of Ocean County, PC
NJAmbulatory Surgical Clinic/CenterNPI 1962568543Tax ID 22-3461117
$5,330.00Published rate
Medstar Medical Group
MDAmbulatory Surgical Clinic/CenterNPI 1730571118Tax ID 46-2691028
$4,480.00Published rate
Sylvan Surgery Center, Inc.
Sylvan Surgery Center Inc
CAAmbulatory Surgical Clinic/CenterNPI 1801822739Tax ID 20-0500901
$1,957.00Published rate
Iowa Endoscopy Center, Inc.
Iowa Endoscopy Center Inc
IAAmbulatory Surgical Clinic/CenterNPI 1609968478Tax ID 42-1407285
$683.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 27814 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 27814 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 27814 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.
27768-CPT	Moderate	Closed Treatmn Of Posteri Malleolus Fract; W/ Manipulat, Closed Treatment Of Posterior Malleolus Fracture; With Manipulation
27810-CPT	Moderate	Closed Treatment Of Bimalleola, Closed Treatment Of Bimalleolar Ankle Fracture E.G. Lateral And Medial Malleoli Or Lateral And Posterior Malleoli Or Medial And Posterior Malleoli) With Manipulation
27814-CPT	High	Treatment Of Ankle Fracture, Open Treatment Of Bimalleolar Ankle Fracture Eg Lateral And Medial Malleoli Or Lateral And Posterior Malleoli Or Medial And Posterior Malleoli Includes Internal Fixation When Performed

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27814. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 27814 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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CPT 27814 Fee Schedule

Summit Orthopedics, Ltd, Plymouth Surgery Center

Endoscopy Center Of Ocean County, LLC

Medstar Medical Group

Sylvan Surgery Center, Inc.

Iowa Endoscopy Center, Inc.