CPT 21011 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21011 |
National average reimbursement for CPT 21011 by major payers:
$434.50
$470.15
$509.53
$625.20
| 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 21011 | ||||||
United | 21011 | $645.00 | 1003110792 - CREVE COEUR SURGERY CENTER, LLC, CITY PLACE SURGERY CENTER | 273332421 - (MO) CREVE COEUR SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $509.00 | 1295700086 - WESTERN WASHINGTON ENDOSCOPY CENTERS, LLC | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $510.00 | 1265964050 - SCHAUMBURG SURGERY CENTER, LLC | 813061805 - (IL) SCHAUMBURG SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $967.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $492.00 | 1558363549 - SUSQUEHANNA VALLEY SURGERY CENTER | 251847818 - (PA) SUSQUEHANNA VALLEY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $823.00 | 1174999700 - ADVANCED SURGERY CENTER OF CENTRAL IOWA, LLC | 472673565 - (IA) ADVANCED SURGERY CENTER OF CENTRAL IOWA LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $475.00 | 1891286860 - SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | 825437441 - (GA) SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $624.00 | 1639618036 - PRESENCE LAKESHORE GASTROENTEROLOGY, LLC | 811750563 - (IL) PRESENCE LAKESHORE GASTROENTEROLOGY LLC DBA DES PLAINES ENDOSCOPY CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $934.00 | 1700502150 - MOUNT PLEASANT OUTPATIENT SURGERY CENTER LLC | 883714959 - (SC) MOUNT PLEASANT OUTPATIENT SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $967.00 | 1518154517 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $919.00 | 1235178146 - SUBURBAN ENDOSCOPY CENTER, LLC, SUBURBAN ENDOSCOPY CENTER | 820556996 - (NJ) SUBURBAN ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $610.00 | 1205171295 - VANCE THOMPSON VISION SURGERY CENTER PROF LLC, VANCE THOMPSON VISION SURGERY CENTER | 843362063 | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $500.00 | 1598276404 - BALBOA NEPHROLOGY MEDICAL GROUP,INC., SAN DIEGO ACCESS AND SURGERY CENTER | 952848091 - (CA) BALBOA NEPHROLOGY MEDICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $473.00 | 1528024114 - AMBULATORY CARE CENTER PA | 223479837 - (NJ) AMBULATORY CARE CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21011 | $831.00 | 1477886406 - BILTMORE SURGICAL PARTNERS, LLC, DEER VALLEY SURGICAL AND ENDOSCOPY CENTER | 264509307 - (AZ) BILTMORE SURGICAL PARTNERS LLC | AZ | 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 21011 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21011 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 21011 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 |
|---|---|---|
| 20974-CPT | Low | Stimulate Bone Electric Noninvasive |
| 20975-CPT | Moderate | Electrical Stim Aid Bone Heal Invasive |
| 20979-CPT | Low | Low Intensity Ultrasound Stimulation To Aid Bone Healing, Noninvasive (Nonoperative) |
| 21011-CPT | Moderate | Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; Less Than 2 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21011 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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