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 |
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 | $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 | $5249.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, 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 | $8238.00 | 1104883784 - FORT WORTH ENDOSCOPY CENTERS, LLC, FORT WORTH ENDOSCOPY CENTER | 770368346 - (TX) FORT WORTH ENDOSCOPY CENTERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $1753.00 | 1396012845 - PREMIER SURGERY CENTER OF PITTSBURGH, LLC | 453477201 - (PA) PREMIER SURGERY CENTER OF PITTSBURGH LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2800.00 | 1528604675 - SURGERY CENTER OF NORTH TEXAS, PLLC | 831353164 - (TX) SURGERY CENTER OF NORTH TEXAS, PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2675.00 | 1770019200 - GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC, GEORGIA CATARACT AND EYE SPECIALTY CENTER | 461115901 - (GA) GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $4132.00 | 1235146325 - WEBSTER AMBULATORY SURGERY CENTER LP, WEBSTER SURGERY CENTER | 205953387 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2680.00 | 1487978789 - CENTER OF MOREHEAD CITY, LLC, THE SURGICAL CENTER OF MOREHEAD CITY | 272095799 - (NC) SURGICAL CENTER OF MOREHEAD | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $7391.00 | 1851354377 - MANATEE SURGICARE LTD | 752367622 - (FL) MANATEE SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $2569.00 | 1811950298 - SOUTH HILL AMBULATORY SURGICAL CENTER PS | 911546856 - (WA) SOUTH HILL AMBULATORY SURGICAL CENTER PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $869.00 | 1902838402 - OUTPATIENT SURGERY CENTER, INC, MARINER SURGERY CENTER | 30504664 - (FL) OUTPATIENT SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $3100.00 | 1790174274 - PARKSIDE SURGERY CENTER, LLC | 472815348 - (TX) PARKSIDE SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $1651.00 | 1235105248 - GURLEY SURGERY CENTER, THE GYN CENTER | 621159796 - (TN) GURLEY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21025 | $4234.00 | 1124083076 - NORTH GARLAND SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - NORTH GARLAND | 562399993 - (TX) NORTH GARLAND SURGERY CENTER LLP | 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 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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