CPT 27860 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 27860 |
National average reimbursement for CPT 27860 by major payers:
$226.22
$207.45
$175.51
$264.47
| 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 27860 | ||||||
United | 27860 | $559.00 | 1801869847 - AESCULAPIAN SURGERY CENTER, LLC, INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CENTER | 920179499 - (FL) AESCULAPIAN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $675.00 | 1417294745 - COAL CREEK AMBULATORY SURGERY CENTER PC, COAL CREEK AMBULATORY SURGERY CENTER | 474079291 - (CO) COAL CREEK AMBULATORY SURGERY CENTER PC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $381.00 | 1659360303 - ST JOHNS SURGERY CENTER LLC | 650502027 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $700.00 | 1396141545 - AXIS SURGERY CENTER LLC | 463623155 - (GA) AXIS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $2832.00 | 1902134372 - METRO SPECIALTY SURGERY CENTER, LLC | 270426722 - (IN) METRO SPECIALTY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $700.00 | 1104822808 - AGMG ENDOSCOPY CENTER A GENERAL PARTNERSHIP | 330885760 - (CA) AGMG ENDOSCOPY CENTER A GENERAL PARTNERSHIP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $2307.00 | 1861657256 - INDIANA ENDOSCOPY CENTERS LLC | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $594.00 | 1346865078 - PANHANDLE OUTPATIENT SURGERY CENTER | 833975146 - (FL) PANHANDLE OUTPATIENT SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $1258.00 | 1851950281 - YUMA ADVANCED SURGICAL SUITES LLC | 833076801 - (AZ) YUMA ADVANCED SURGICAL SUITES, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $758.00 | 1780618801 - PINEY ORCHARD SURGERY CENTER, LLC. | 521938770 - (MD) PINEY ORCHARD SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $1258.00 | 1467796730 - WINDSOR MILL SURGERY CENTER, LLC | 461412275 - (MD) WINDSOR MILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $725.00 | 1386213460 - GEORGIA INTERVENTIONAL PAIN | 854240994 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $1000.00 | 1255896676 - ASCENTIST ASC MERRIAM, LLC, ASCENTIST EAR, NOSE AND THROAT INSTITUTE | 831973214 - (KS) ASCENTIST ASC MERRIAM LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $620.00 | 1255397964 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 27860 | $1158.00 | 1508040486 - PORTLAND CLINIC, ROGER E. ALBERTY, M.D. SURGICAL CENTER | 930400952 - (OR) THE PORTLAND CLINIC LLP | OR | 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 27860 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 27860 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 27860 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 |
|---|---|---|
| 27840-CPT | Moderate | Red Disloc-Ankle Wo Anesthesia |
| 27842-CPT | Moderate | Clo Tx Ank Disloc W/Anes W/Wo Fix |
| 27846-CPT | High | Open Treatment Of Ankle Dislocation, With Or Without Percutaneous Skeletal Fixation; Without Repair Or Internal Fixation |
| 27860-CPT | Moderate | Manipulation Ankle W Gen Anes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 27860 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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