CPT 13121 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 Integumentary System |
| Common Place of Service | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 13121 |
National average reimbursement for CPT 13121 by major payers:
$470.68
$538.75
$567.79
$704.78
| 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 13121 | ||||||
United | 13121 | $574.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13121 | $110.00 | 1043272750 - WEST PARK SURGERY CENTER LLC | 260092101 - (FL) WEST PARK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13121 | $290.79 | 1336259852 - ANN CLEMENTS | 593549147 | FL | Physician Assistant (363A00000X) |
United | 13121 | $362.07 | 1225579618 - OKSANA EVANS | 593549147 | FL | Medical Physician Assistant (363AM0700X) |
United | 13121 | $362.07 | 1336259886 - JERE MAMMINO | 593549147 | FL | Dermatology Physician (207N00000X) |
United | 13121 | $305.85 | 1851400485 - GEORGE HEMSTREET | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | 13121 | $544.00 | 1225123227 - COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | 770533953 - (CA) COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13121 | $441.73 | 1720079270 - FAKHIR ELMASRI | 591262719 - (FL) RADIOLOGY AND IMAGING SPECIALISTS OF LAKELAND, P.A. | FL | Vascular & Interventional Radiology Physician (2085R0204X) |
United | 13121 | $362.07 | 1427094994 - TARA DUQUETTE | 593549147 | FL | Physician Assistant (363A00000X) |
United | 13121 | $521.36 | 1497915623 - JEANEEN CHAPPELL | 752286998 | TX | Dermatology Physician (207N00000X) |
United | 13121 | $555.00 | 1992992994 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13121 | $412.39 | 1164531166 - JING GILL | 582082140 | GA | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 13121 | $717.97 | 1316175128 - BRENT TAYLOR | 473011659 | FL | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 13121 | $114.00 | 1245331628 - BERNSTEIN HILLIKER HARTZELL EYE CENTER LLP, THE SURGERY CENTER OF CENTRAL PA | 232196399 - (PA) THE EYE CENTER OF CENTRAL PA, LLP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13121 | $290.79 | 1033416565 - CARLY TANNER | 593549147 | FL | Physician Assistant (363A00000X) |
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 13121 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 13121 code is part of the Surgery services used for Surgical Procedures on the Integumentary 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 13121 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 |
|---|---|---|
| 12020-CPT | Moderate | Closure Superfic Wound Dehiscence |
| 13120-CPT | Moderate | Complx Rpr Sclp Arm Leg 1.1-2.5 Cm |
| 13121-CPT | Moderate | Rep Complex Scalp/Limb 2.5-7.5 Cm |
| 13122-CPT | Low | Repair, Complex, Scalp, Arms, And/Or Legs; Each Additional 5 Cm Or Less (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 13121. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 13121 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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