CPT 21123 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21123 |
National average reimbursement for CPT 21123 by major payers:
$1,076.38
$1,168.79
$1,177.28
$1,447.64
| 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 21123 | ||||||
United | 21123 | $850.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 463285029 - (GA) CENTER FOR PAIN AND SPINE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1842.00 | 1003887225 - CENTRAL TEXAS ENDOSCOPY CENTER LLC, CENTRAL TEXAS ENDOSCOPY CENTER | 742863853 - (TX) CENTRAL TEXAS ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1030.13 | 1053360107 - ADVANCED EYE SURGERY CENTER | 204771266 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $3144.43 | 1649748708 - ANKENY MEDICAL PARK SURGERY CENTER LC | 831281114 - (IA) ANKENY MEDICAL PARK SURGERY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2388.00 | 1366684326 - PRINCE FREDERICK SURGERY CENTER LLC | 264387021 - (MD) PRINCE FREDERICK SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1563.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1727.00 | 1891865077 - REGENCY SURGERY CENTER, LLC | 710973677 - (CA) REGENCY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2025.00 | 1437112455 - SPACE COAST SURGICAL CENTER LTD, MERRITT ISLAND SURGERY CENTER | 752516426 - (FL) SPACE COAST SURGICAL CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1387.00 | 1144970112 - SONORAN ENDOSCOPY CENTER LLC | 852760027 - (AZ) SONORAN ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2353.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2859.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $5048.00 | 1396175246 - MEMORIAL HERMANN BAY AREA ENDOSCOPY CENTER, LLC, BAY AREA ENDOSCOPY | 364773048 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $1414.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2762.00 | 1245820042 - ALOE SURGICAL CENTER SCOTTSDALE, LLC | 845112576 - (AZ) ALOE SURGICAL CENTER SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21123 | $2595.00 | 1144275900 - MT LAUREL ENDOSCOPY CENTER L P | 562350370 - (NJ) MT LAUREL ENDOSCOPY CENTER L P | NJ | 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 21123 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21123 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 21123 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 |
|---|---|---|
| 21120-CPT | Moderate | Genioplasty; Augmentation (Autograft, Allograft, Prosthetic Material) |
| 21121-CPT | Moderate | Genioplasty Sliding Osteotomy Single Pie |
| 21122-CPT | Moderate | Genioplasty; Sliding Osteotomies, 2 Or More Osteotomies (Eg, Wedge Excision Or Bone Wedge Reversal For Asymmetrical Chin) |
| 21123-CPT | High | Genioplasty; Sliding, Augmentation With Interpositional Bone Grafts (Includes Obtaining Autografts) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21123. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21123 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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