CPT 21015 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21015 |
National average reimbursement for CPT 21015 by major payers:
$852.26
$868.31
$924.80
$1,119.65
| 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 21015 | ||||||
United | 21015 | $622.00 | 1710924899 - DMG SURGICAL CENTER LLC, SURGICAL CENTER OF DUPAGE MEDICAL GROUP | 371474161 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $1137.00 | 1497706626 - CHICAGO PROSTATE CANCER SURGERY CENTER, LLC, DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT | 204403852 - (IL) CHICAGO PROSTATE CANCER SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $925.00 | 1588046361 - NIAGARA ASC, LLC, ASC OF NIAGARA | 463471081 - (NY) NIAGARA ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $800.00 | 1376716316 - CPM SURGERY CENTER LLC | 261382311 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $380.00 | 1881699106 - CENTER FOR DAY SURGERY | 621845006 - (TN) CENTER FOR DAY SURGERY | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $515.00 | 1902981558 - LANE SURGERY CENTER, LLC | 931305103 - (OR) LANE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $455.00 | 1295739217 - WATERSIDE AMBULATORY SURGICAL CENTER LLC | 650270415 - (FL) WATERSIDE AMBULATORY SURGICAL CE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $365.00 | 1124443809 - POOLE ENDOSCOPY CENTER, LLC | 521831316 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $700.00 | 1568513950 - MASSACHUSETTS AVENUE SURGERY CENTER | 200815305 - (MD) MASSACHUSETTS AVENUE SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $400.00 | 1538242649 - SOUTHWESTERN ENDOSCOPY CENTER, LLC | 571139709 - (PA) SOUTHWESTERN ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $2209.00 | 1578558763 - HUNT MEMORIAL HOSPITAL DISTRICT, HUNT REGIONAL HEALTHCARE | 751277293 - (TX) HUNT MEMORIAL HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $1235.30 | 1255473625 - HILARY NWOSU | 350593390 - DEACONESS HOSPITAL INC | CA | Emergency Medicine Physician (207P00000X) |
United | 21015 | $1188.00 | 1316189095 - CARILLON SURGERY CENTER LLC | 261116740 - (FL) CARILLON SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $985.00 | 1366065674 - SOUTH DENVER SURGICAL SERVICES LLC, SOUTH DENVER UROLOGY CENTER | 850873977 - (CO) SOUTH DENVER SURGICAL SERVICES LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21015 | $800.00 | 1790174274 - PARKSIDE SURGERY CENTER, LLC | 472815348 - (TX) PARKSIDE SURGERY CENTER | TX | 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 21015 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21015 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 21015 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 21015. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21015 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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