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See a sample rate comparisonCPT 21016 Fee Schedule
Medicare rates as of October 2026
CPT 21016 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | 22On Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | 51Multiple procedures ASPA/NP/CNS assistant at surgery |
| Hospital Outpatient Group (APC) | APC 5073 - Level 3 Excision/ Biopsy/ Incision and Drainage |
| Surgery Center Payment (ASC) | G2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600761Sign up to view all 3 |
| Medicare Fee Schedule | $901.49 national non-facility rate (2026)View Medicare rates for 21016 |
| Medicaid Fee Schedule | $711.965 median of the 8 states in the free previewView Medicaid rates for 21016 |
National average reimbursement for CPT 21016 by major payers:
$1,380.74
BCBS / Anthem
$1,399.65
UnitedHealthcare
$1,439.91
Aetna
$1,682.10
Cigna
Compare published rates across providers.
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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 table lists codes related to 21016. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21013-CPT | Exc Face Tum Deep 2 Cm, Excision Tumor Soft Tissue Of Face And Scalp Subfascial Eg Subgaleal Intramuscular Less Than 2 Cm |
| 21014-CPT | Excision Tumor Soft Tissue O, Excision Tumor Soft Tissue Of Face And Scalp Subfascial (Eg Subgaleal Intramuscular) 2 Cm Or Greater |
| 21015-CPT | 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 | 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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Frequently Asked Questions
What APC is CPT 21016 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21016 to APC 5073 (Level 3 Excision/ Biopsy/ Incision and Drainage). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21016 in an ambulatory surgery center?
CMS lists CPT 21016 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21016?
Hospital price transparency files list CPT 21016 under these revenue codes: 0360, 0761 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.