CPT 21048 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 • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21048 |
National average reimbursement for CPT 21048 by major payers:
$1,461.97
$1,449.77
$1,454.19
$1,758.75
| 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 21048 | ||||||
United | 21048 | $2800.00 | 1164986683 - PROFFER SURGICAL CENTER, PLLC | 823343890 - (TX) PROFFER SURGICAL CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $1794.00 | 1093799405 - ORTHOARKANSAS SURGERY CENTER LLC | 710818555 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2629.00 | 1225377278 - CENTER FOR MINIMALLY INVASIVE SURGERY PLLC, SOUNDVIEW AMBULATORY SURGERY CENTER | 911661866 - (WA) CENTER FOR MINIMALLY INVASIVE SURGERY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2852.00 | 1003168907 - CANDESCENT EYE HEALTH SURGICENTER, LLC | 460608742 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2585.00 | 1740491422 - PV PENINSULA PLASTIC SURGERY CENTER | 208545497 - (CA) PV PENINSULA PLASTIC SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2300.00 | 1174938344 - SPECIALTY SURGERY CENTER, LLC | 455554765 - (MS) SPECIALTY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $5433.00 | 1275682627 - SUMMIT VIEW SURGERY CENTER, LLC | 20659552 - (CO) SUMMIT VIEW SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $971.00 | 1063593952 - CONNECTICUT GI ENDOSCOPY CENTER LLC | 61573358 - (CT) CONNECTICUT GI ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2726.00 | 1639499627 - GEORGIA UROLOGY, PA, GEORGIA UROLOGY ASC MARIETTA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $4703.00 | 1942267893 - GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA | 223345724 - (NJ) GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2528.00 | 1881319127 - PRIME SURGERY CENTER | 872283379 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $5249.00 | 1992706899 - SURGERY CENTER OF PEORIA, LLC, SURGERY CENTER OF PEORIA | 731538768 - (AZ) SURGERY CENTER OF PEORIA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $4234.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $5002.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21048 | $2431.00 | 1952535502 - PLATEAU SURGERY CENTER | 264769256 - (TN) PLATEAU SURGERY CENTER | TN | 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 21048 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21048 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 21048 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 |
|---|---|---|
| 21034-CPT | High | Exc Malig Tumor Facial Bone |
| 21040-CPT | Moderate | Excis Lesion Mandible Simple |
| 21046-CPT | High | Excision Of Benign Tumor Or Cyst Of Mandible; Requiring Intra-Oral Osteotomy (Eg, Locally Aggressive Or Destructive Lesion(S)) |
| 21048-CPT | High | Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Intra-Oral Osteotomy (Eg, Locally Aggressive Or Destructive Lesion(S)) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21048. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21048 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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