CPT 21085 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 | • 11 - Office • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 52 - Reduced Services |
| Complexity Level | Moderate |
National average reimbursement for CPT 21085 by major payers:
$831.25
$960.45
$966.06
$1,182.99
| 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 21085 | ||||||
United | 21085 | $595.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $150.00 | 1518106681 - GEORGIA SURGICAL CENTERS SOUTH, INC | 43650858 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $225.00 | 1831441617 - PLANNED PARENTHOOD OF GREATER TEXAS SURGICAL HEALTH SERVICES | 201121091 - (TX) PLANNED PARENTHOOD OF GREATER TEXAS SURGICAL HEALTH SERVICES | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $363.00 | 1033363064 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM SURGERY CENTER | 300466706 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $290.00 | 1346969789 - ADVENTHEALTH SURGERY CENTER INNOVATION TOWER, LLC | 882744377 - (FL) ADVENTHEALTH SURGERY CENTER INNOVATION TOWER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $200.00 | 1588203723 - SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER, LLC | 832560085 - (AZ) SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $110.00 | 1134687981 - ARMENIA AMBULATORY SURGICAL CENTER, LLC | 833888664 - (FL) ARMENIA AMBULATORY SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $855.00 | 1477594422 - SURGERY CENTER OF AVENTURA LTD | 113765789 - (FL) SURGERY CENTER OF AVENTURA LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $1284.68 | 1568935344 - JAMES GILSTRAP | 350593390 - DEACONESS HOSPITAL INC | MO | Certified Registered Nurse Anesthetist (367500000X) |
United | 21085 | $245.00 | 1639149255 - COLD SPRINGS MEDICAL SURGICAL GROUP LLC, DE LA VINA SURGICENTER | 770521530 - (CA) COLD SPRINGS MEDICAL SURGICAL GROUP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $88.00 | 1386618783 - LEWES DE ENDOSCOPY ASC LLC, SEASIDE ENDOSCOPY PAVILION | 562299727 - (DE) LEWES DE ENDOSCOPY ASC LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $1284.68 | 1730412826 - RAMIN RASHIDIAN | 350593390 - DEACONESS HOSPITAL INC | KY | Internal Medicine Physician (207R00000X) |
United | 21085 | $182.00 | 1952885543 - REGENERATIVE ORTHOPAEDICS SURGERY CENTER, LLC | 824793737 - (GA) REGENERATIVE ORTHOPAEDICS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $186.00 | 1689200305 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21085 | $344.00 | 1528000817 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | 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 21085 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21085 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 21085 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 |
|---|---|---|
| 21079-CPT | High | Impress/Prep Interim Obturator |
| 21081-CPT | High | Impress/Prep Mandibular Resection |
| 21082-CPT | High | Impress Custom Prep Palatal Augmentation |
| 21085-CPT | Moderate | Impression & Custom Preparation; Oral Surgical Splint -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21085. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21085 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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