CPT 21013 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21013 |
National average reimbursement for CPT 21013 by major payers:
$683.82
$701.65
$756.04
$904.58
| 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 21013 | ||||||
United | 21013 | $440.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $1571.00 | 1952945156 - PHYSICIANS WEST SURGICENTER, LLC | 843452204 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $552.00 | 1679566582 - FOREST CANYON ENDOSCOPY & SURGERY CTR PC | 460504121 - (AZ) FOREST CANYON ENDOSCOPY & SURGERY CENTER, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $289.00 | 1144482753 - CLARKSVILLE EYE SURGERY CENTER | 261815638 - (TN) CLARKSVILLE EYE SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $784.00 | 1306217039 - FIRST HILL SURGERY CENTER LLC | 472066485 - (WA) FIRST HILL SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $355.00 | 1710952882 - ADVANCED DERMATOLOGY AND SKIN SURGERY, PLLC | 813253496 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $550.00 | 1316342579 - ENCINO SURGICAL CENTER LLC | 471132992 - (CA) ENCINO SURGICAL CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $472.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $144.00 | 1285736207 - PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER, PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC | 522197193 - (MD) PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $200.00 | 1952404550 - WEST PALM BEACH CHILDREN'S SURGERY CENTER, LLC | 650789191 - (FL) WEST PALM BEACH CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $425.00 | 1972156842 - NORMAN REGIONAL HOSPITAL AUTHORITY, MEDICAL PLAZA ENDOSCOPY | 736048282 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $2350.00 | 1508837899 - MEMORIAL HERMANN SURGERY CENTER NORTHWEST, LLP, MEMORIAL HERMANN SURGERY CENTER GREATER HEIGHTS | 200689650 - (TX) MEMORIAL HERMANN SURGERY CENTER NORTHWEST LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $450.00 | 1669577524 - SKIN & MOHS SURGERY CENTER, LLC | 431823843 - SKIN MOHS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $613.00 | 1942265939 - INLAND SURGERY CENTER LP | 330018673 - (CA) INLAND SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21013 | $425.00 | 1144983990 - MOUNTAIN WEST SURGICAL CENTER, LLC | 844185465 - (NV) MOUNTAIN WEST SURGICAL CENTER LLC | NV | 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 21013 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21013 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 21013 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 |
|---|---|---|
| 21013-CPT | Moderate | Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial (Eg, Subgaleal, Intramuscular); Less Than 2 Cm |
| 21014-CPT | Moderate | Exc Tumor Soft Tiss Face & Scalp Subfascial 2 Cm |
| 21015-CPT | Moderate | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Face Or Scalp; Less Than 2 Cm (Revised 01/01/2014) |
| 21016-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Face Or Scalp; 2cm Or Greater (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21013. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21013 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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