CPT 27816 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 | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • 54 - Surgical Care Only • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 27816 by major payers:
$416.99
$426.80
$451.55
$556.21
| 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 27816 | ||||||
United | 27816 | $105.00 | 1417333295 - IDOX3 LLC, TRI-STATE SURGERY CENTER | 473757893 - (OH) IDOX3 LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $746.00 | 1780853044 - HACIENDA SURGERY CENTER, LLC | 320439356 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $1081.00 | 1649520057 - MUNSTER SPECIALTY SURGERY CENTER, LLC, MUNSTER SPECIALTY SURGERY CENTER | 454918544 - (IN) MUNSTER SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $175.00 | 1760869093 - ORTHOPEDIC AMBULATORY SURGERY CENTER OF CHESTERFIELD, LLC | 473506918 - (MO) ORTHOPEDIC AMBULATORY SURGERY CENTER OF CHESTERFIELD LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $116.00 | 1811947062 - WACO GASTROENTEROLOGY ENDOSCOPY CENTER LLC, WACO GASTROENTEROLOGY ENDOSCOPY CENTER | 43636953 - (TX) WACO GASTROENTEROLOGY ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $248.00 | 1730698374 - ADVANCED SURGICAL CENTER OF SUNSET HILLS LLC | 821806934 - (MO) ADVANCED SURGICAL CENTER OF SUNSET HILLS, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $140.00 | 1063935286 - CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY | 821592877 - (WA) CLINIC 5C | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $803.00 | 1013962521 - NEWPORT PLAZA SURGERY CENTER | 392060266 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $375.00 | 1053481960 - AESTHETIC ASSOCIATES INC., P.S., SEATTLE FACIAL PLASTIC SURGERY CENTER | 911650765 - (WA) AESTHETIC ASSOCIATES INC PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $315.00 | 1922011501 - LOWERY A. WOODALL OUTPATIENT SURGERY FACILITY, LLC | 640897321 | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $175.00 | 1194245951 - PSG SURGERY CENTER LLC, SURGERY CENTER OF AMARILLO | 821476685 - (TX) PSG SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $438.00 | 1497165179 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF PHOENIX | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $113.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $1202.00 | 1821642661 - STEAMBOAT SURGERY CENTER, LLC | 834367630 - (CO) STEAMBOAT SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27816 | $736.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | 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 27816 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27816 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 27816 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 |
|---|---|---|
| 27769-CPT | High | Optx Post Ankle Fx |
| 27814-CPT | High | 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 |
| 27816-CPT | Moderate | Clo Tx Trimalleolar Ank Fx Wo Manip |
| 27818-CPT | Moderate | Tx Closed Trimalleolar Ankle Fx;W Manipu |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27816 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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