CPT 21070 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21070 |
National average reimbursement for CPT 21070 by major payers:
$854.35
$843.15
$869.99
$1,043.83
| 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 21070 | ||||||
United | 21070 | $5354.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $5731.00 | 1467057372 - SOUTHWEST CONNECTICUT SURGERY CENTER, LLC | 852607391 - (CT) SOUTHWEST CONNECTICUT SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $5249.00 | 1851710735 - SURGCENTER TUCSON, LLC | 462350774 - (AZ) SURGCENTER TUCSON, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $5249.00 | 1942507488 - GA ENDOSCOPY CENTER, LLC | 273115800 - (GA) GA ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $1245.00 | 1114951365 - DOCTORS SURGERY CENTER, PA | 710718664 - (AR) DOCTORS SURGERY CENTER PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $3100.00 | 1487117370 - LIBERTY CORNER SURGICAL CENTER LLC | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $2137.00 | 1710336763 - MT PLEASANT SURGERY CENTER LLC | 300872082 - (MI) MT PLEASANT SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $2483.00 | 1720514359 - JOHNS HOPKINS SURGERY CENTERS SERIES, KNOLL NORTH SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $1857.00 | 1770645905 - SILVER SPRING MD ENDOSCOPY ASC LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND | 205988845 - (MD) SILVER SPRING MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $2142.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $3935.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $1230.00 | 1093960395 - GRAYSTONE EYE SURGERY CENTER LLC | 205740206 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $1478.00 | 1336255827 - ROCKVILLE EYE SURGERY CENTER, LLC, PALISADES EYE SURGERY CENTER | 43713185 - (MD) PALISADES EYE SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $1374.00 | 1922193515 - MAHONING VALLEY AMBULATORY SURGERY CENTER INC | 233056394 - (PA) MAHONING VALLEY AMBULATORY SURGERY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21070 | $3868.00 | 1154318103 - OPTUM CARE WASHINGTON PLLC, OPTUM - KEMP SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | 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 21070 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21070 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 21070 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 |
|---|---|---|
| 21050-CPT | High | Condylecyomy Temporomandibular |
| 21060-CPT | High | Meniscectomy Temporomandibular |
| 21070-CPT | Moderate | Coronoidectomy Unilateral |
| 21073-CPT | Moderate | Once Per Dos Manipulation Of Temporomandibular Joint, Tmj, Therapeutic, Requiring An Anesthesia Service- Rn Review: Medicaid>=5/14/2011, Commercial>=7/5/2011 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21070. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21070 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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