CPT 21016 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 21016 by major payers:
$1,380.74
$1,399.65
$1,439.91
$1,719.89
| 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 21016 | ||||||
United | 21016 | $2307.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $813.16 | 1336523539 - KARA DOUCET | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 21016 | $813.16 | 1942224001 - KRISTI COTTRELL | 350593390 - DEACONESS HOSPITAL INC | CA | Nurse Practitioner (363L00000X) |
United | 21016 | $1146.00 | 1578535233 - SUN CITY OPHTHALMOLOGY ASC LLC, EYE INSTITUTE AT BOSWELL | 621737549 - (AZ) SUN CITY OPHTHALMOLOGY ASSOC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $2353.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $1769.83 | 1023462744 - EVAN GREEN | 350593390 - DEACONESS HOSPITAL INC | NY | Student in an Organized Health Care Education/Training Program (390200000X) |
United | 21016 | $1769.83 | 1952388183 - BARRY GEST | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 21016 | $967.00 | 1578898276 - SOUTHERN UROLOGY SURGERY CENTER, LLC | 270881751 - (MS) SOUTHERN UROLOGY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $968.00 | 1790822864 - NORTHWEST EYE SPECIALISTS,LLC | 860720868 - (AZ) NORTHWEST EYE SPECIALISTS, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $1153.00 | 1740776517 - TAKLE EYE SURGERY CENTER LLC | 823838597 - (GA) TAKLE EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $1005.00 | 1083920151 - HILLMOOR EYE SURGERY CENTER, LLC, ONE DAY SURGERY | 273127763 - (FL) HILLMOOR EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $1769.83 | 1841273968 - KRISHNA CHILUKURI | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 21016 | $530.00 | 1679025449 - DIGESTIVE HEALTH COMPLEX | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $1250.00 | 1619971470 - ARIZONA ADVANCED SURGERY CENTER, LLC | 202770438 - (AZ) ARIZONA ADVANCED SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21016 | $2353.00 | 1265466288 - TAMARAC SURGERY CENTER LLC, THE SURGERY CENTER OF FT LAUDERDALE | 650963549 - (FL) TAMARAC SURGERY CENTER LLC | FL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 | 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 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21016) and we'll show you how you compare in 15 minutes or less.