How much does Medicare pay for CPT 27245?

Medicare allowed an average of $1034.24 per service and paid $821.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4652.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27245?

Treatment of broken neck of thigh bone with bone implant. It was billed 41,978 times to 41,746 Medicare beneficiaries by 2,292 providers in 2024.

Which specialty bills 27245 most?

Orthopedic Surgery, with 34,623 services from 1,853 clinicians. Next are Physician Assistant, Nurse Practitioner, Sports Medicine.

CPT 27245

Treatment of broken neck of thigh bone with bone implant

$1034.24Medicare-allowed amount per service, averaged across 41,978 services

Providers submitted

$4652.90

Asking price, not received

Medicare allowed

$1034.24

The fee schedule figure

Medicare paid

$821.73

Balance is patient coinsurance

Providers submitted an average of $4652.90 for this code and Medicare allowed $1034.24 — 4.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $821.73 (79%); the rest is the patient’s coinsurance and deductible.

Services: 41,978
Beneficiaries: 41,746
Providers billing it: 2,292
Total allowed: $43,415,327

What Medicare pays for CPT 27245

Across 41,978 services billed by 2,292 providers to 41,746 beneficiaries, Medicare allowed an average of $1034.24 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 27245

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	34,623	34,423	$1202.21	1,853
Physician Assistant	5,736	5,713	$164.56	337
Nurse Practitioner	1,041	1,035	$160.55	65
Sports Medicine	282	281	$1218.62	18
Hand Surgery	162	161	$1186.99	12
Emergency Medicine	60	60	$1212.41	3
General Surgery	37	37	$799.74	2
Osteopathic Manipulative Medicine	22	21	$1107.49	1
Internal Medicine	15	15	$1164.79	1

27245 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	5,396	$984.06	$749.15	279
California	3,474	$1120.56	$845.21	193
Texas	3,343	$1018.51	$819.01	180
New York	2,046	$1294.94	$899.01	94
Illinois	1,649	$1068.06	$793.99	85
Pennsylvania	1,513	$1094.26	$871.11	80
Arizona	1,471	$906.29	$728.24	81
Virginia	1,295	$1136.34	$899.00	68
New Jersey	1,209	$1205.79	$888.15	70
Ohio	1,126	$1068.29	$872.41	62
Tennessee	1,037	$1026.71	$879.26	62
Massachusetts	1,035	$1228.49	$930.40	50
North Carolina	1,025	$1062.43	$866.73	57
Georgia	1,005	$956.05	$766.45	52
Missouri	949	$977.85	$802.95	52
South Carolina	927	$997.82	$823.21	49
Michigan	915	$1134.00	$880.17	50
Maryland	883	$1217.41	$913.03	43
Indiana	874	$851.40	$725.63	51
Oklahoma	808	$1008.04	$849.53	45
Minnesota	682	$945.42	$774.16	45
Alabama	681	$734.84	$640.28	42
Louisiana	652	$829.35	$676.21	40
Arkansas	584	$957.63	$845.40	37
Washington	583	$1084.57	$853.04	36
Kansas	575	$858.95	$738.87	27
Kentucky	569	$1027.25	$861.48	32
Mississippi	523	$1061.51	$917.33	29
Iowa	478	$828.22	$701.06	29
Colorado	455	$1022.93	$801.84	30
Nevada	400	$1082.39	$875.26	18
Wisconsin	390	$943.56	$789.44	26
Delaware	377	$845.94	$679.17	19
South Dakota	350	$774.72	$655.95	16
Oregon	320	$907.80	$733.28	20
New Mexico	277	$995.12	$794.14	17
Connecticut	237	$1118.90	$839.23	17
New Hampshire	230	$972.05	$754.85	12
West Virginia	228	$947.22	$745.17	13
Utah	228	$931.37	$770.38	15
Nebraska	219	$1003.42	$873.93	14
Maine	201	$841.98	$697.53	13
North Dakota	192	$968.56	$792.96	9
Montana	145	$787.39	$615.04	8
Wyoming	86	$574.60	$467.48	3
Idaho	83	$1111.24	$956.34	5
Rhode Island	81	$1192.45	$947.45	5
District of Columbia	53	$706.66	$509.72	3
Vermont	47	$1174.60	$959.61	4
Alaska	41	$1508.21	$960.07	3
Hawaii	31	$1203.63	$931.72	2

Related codes

27236Treatment of upper end of broken thigh bone$983.38
27279Fusion of pelvic joint$5445.92
27280Fusion of sacroiliac joint between spine and pelvis$1317.55

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.