CPT 10021 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 • General Surgical Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 10021 by major payers:
$133.51
$148.14
$155.84
$185.60
| 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 10021 | ||||||
United | 10021 | $124.45 | 1548575368 - DEREK HAVERLEY | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Orthopedic Physical Therapist (2251X0800X) |
United | 10021 | $175.00 | 1487014361 - GRIFFIN CENTER FOR PAIN AND SPINE | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $566.00 | 1437419660 - ADVANCED SURGERY CENTER OF METAIRIE LLC | 453386956 - (LA) ADVANCED SURGERY CENTER OF METAIRIE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $1511.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $161.67 | 1497207336 - APRIL CRUICKSHANK | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Medical Physician Assistant (363AM0700X) |
United | 10021 | $790.00 | 1740231489 - STONEGATE SURGERY CENTER LP | 201211544 - (TX) STONEGATE SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $113.94 | 1003690959 - MOLLIE BABICH | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 10021 | $74.50 | 1831684034 - SARAH DWYER PERZOW | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Clinical Child & Adolescent Psychologist (103TC2200X) |
United | 10021 | $161.67 | 1972829737 - BRENDA GEORGE | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | CO | Neurology Physician (2084N0400X) |
United | 10021 | $322.35 | 1902395593 - STEVEN KAPELES | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Anesthesiology Physician (207L00000X) |
United | 10021 | $418.47 | 1659456309 - JESSICA CHURCH | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Acute Care Nurse Practitioner (363LA2100X) |
United | 10021 | $322.35 | 1962530162 - SHAWNA VANDERHOOF | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Optometrist (152W00000X) |
United | 10021 | $818.00 | 1346249604 - ST. MARY'S SURGICAL CENTER LLC, ST. MARY'S SURGICAL CENTER | 201685516 - (MO) ST MARYS SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $125.00 | 1982186425 - CENTER FOR SPINE & PAIN MEDICINE PC, CSPM GSV ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 10021 | $124.45 | 1144777350 - GIOVANNA CANTOR | 800348943 - POUDRE VALLEY MEDICAL GROUP LLC | FL | Family Nurse Practitioner (363LF0000X) |
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 10021 vs. Other General Surgical Procedures Codes
The CPT 10021 code is part of the Surgery services used for General Surgical Procedures. 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 10021 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 |
|---|---|---|
| 10004-CPT | Low | Fine Needle Aspiration Biopsy, Without Imaging Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10005-CPT | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; First Lesion |
| 10006-CPT | Low | Fine Needle Aspiration Biopsy Including Ultrasound Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 10021-CPT | Low | Fine Needle Aspiration Biopsy Without Imaging Guidance; First Lesion (Desc Rvsd 1/1/19) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 10021. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 10021 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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