CPT 21025 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21025 |
National average reimbursement for CPT 21025 by major payers:
$1,069.77
$1,140.52
$1,157.02
$1,388.05
| 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 21025 | ||||||
United | 21025 | $3275.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2650.00 | 1760518609 - NORTH POINT SURGERY CENTER, INC | 770557917 - (CA) NORTH POINT SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $3850.00 | 1396120168 - STAMFORD ASC LLC | 465569848 - (CT) STAMFORD ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $6506.00 | 1841605318 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER, LLC, FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER-CITRUS PARK | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $4839.00 | 1891701611 - ESSEX ENDOSCOPY CENTER LLC | 223777761 - (NJ) ESSEX ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2919.00 | 1346969789 - ADVENTHEALTH SURGERY CENTER INNOVATION TOWER, LLC | 882744377 - (FL) ADVENTHEALTH SURGERY CENTER INNOVATION TOWER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $5433.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2693.00 | 1609996149 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $700.00 | 1801827993 - SOUTH CAROLINA ENDOSCOPY CENTER | 571125931 - (SC) SOUTH CAROLINA ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $3405.00 | 1962011775 - CLEARWAY SURGERY CENTER OF PRINCE FREDERICK LLC | 844787769 - (MD) CLEARWAY SURGERY CENTER OF PRINCE FREDERICK LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2050.00 | 1689236242 - LEE MEMORIAL HEALTH SYSTEM, LEE HEALTH UROLOGY SURGERY CENTER | 843798404 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $3193.00 | 1548226442 - ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO LP | 631166884 - (CA) ARTHROSCOPIC & LASER SURGERY CENTER OF SAN DIEGO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $1974.00 | 1093214819 - PREMIER SURGICAL CENTER, LLC | 823438730 - (MS) PREMIER SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2240.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $1415.00 | 1710985445 - HERSHEY ENDOSCOPY CENTER, LLC | 562336622 - (PA) HERSHEY ENDOSCOPY CENTER, LLC | PA | 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 21025 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21025 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 21025 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 |
|---|---|---|
| 21025-CPT | High | Excision Mandible |
| 21026-CPT | Moderate | Exc Bone Facial Bones Osteomyelitis/A |
| 21029-CPT | Moderate | Removal By Contouring Of Benign Tumor Of Facial Bone -Commercial Rn Review=8/1/2001-5/31/2022: Medicaid Rn Review=8/1/2001-9/30/2020 |
| 21030-CPT | Moderate | Exc Benign Tumor/Cyst Facial Bone Not M |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21025. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21025 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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