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See a sample rate comparisonCPT 21016 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Face Or Scalp, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Face Or Scalp
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21016 |
| Medicaid Fee Schedule | View Medicaid rates for 21016 |
National average reimbursement for CPT 21016 by major payers:
$1,380.74
$1,399.65
$1,439.91
$1,682.10
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CPT 21016
5 of 25 sample ratesHigher to lower in this preview
Surgery Affiliate Of El Paso, LLC, Foundation Surgery Affiliate Of El Paso, LLC
Surgery Affiliate Of El Paso LLC
$8,791.00Published rateTamarac Surgery Center LLC, The Surgery Center Of Ft Lauderdale
Tamarac Surgery Center LLC
$2,353.00Published ratePhysicians Clinic Inc
$1,526.00Published rateAbingdon Surgical Center PC
$1,050.00Published rateRochester Endoscopy & Surgery Center, L.L.C.
Rochester Endoscopy Surgery Center LLC
$638.00Published rate
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See a sample payer proposalCPT 21016 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21016 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 21016 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 | Exc Face Tum Deep 2 Cm, Excision Tumor Soft Tissue Of Face And Scalp Subfascial Eg Subgaleal Intramuscular Less Than 2 Cm |
| 21014-CPT | Moderate | Excision Tumor Soft Tissue O, Excision Tumor Soft Tissue Of Face And Scalp Subfascial (Eg Subgaleal Intramuscular) 2 Cm Or Greater |
| 21015-CPT | Moderate | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Face Or Scalp, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Face Or Scalp |
| 21016-CPT | High | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Face Or Scalp, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Face Or Scalp |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21016 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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