CPT 21125 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 • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21125 |
National average reimbursement for CPT 21125 by major payers:
$3,072.43
$3,726.69
$3,675.29
$4,559.60
| 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 21125 | ||||||
United | 21125 | $2388.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $3394.20 | 1548787203 - DEACONESS HOSPITAL, INC., <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Radiology Clinic/Center (261QR0200X) |
United | 21125 | $2265.00 | 1275281370 - MASS GENERAL BRIGHAM AMSURG INC. | 854372153 - (NH) MASS GENERAL BRIGHAM INCORPORATED | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $2025.00 | 1457545980 - SAND LAKE SURGERY CENTER, LP, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1503.00 | 1649944521 - PRECISION BONE AND JOINT SURGERY CENTER | 861302912 - (FL) PRECISION BONE AND JOINT SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1611.00 | 1396213294 - UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | 831320776 - (OH) UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $670.00 | 1295793974 - SANTA LUCIA SURGICAL CENTER LLC | 201918525 - (FL) SANTA LUCIA SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1269.00 | 1871529388 - PRG DALLAS ASC, LLC, CENTRAL POINT SURGERY CENTER | 752835144 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $850.00 | 1174670723 - GASTROINTESTINAL INSTITUTE, LLC. | 201622626 - (IL) GASTROINTESTINAL INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1300.00 | 1598858714 - MISSION VALLEY HEGIHTS SURGERY CENTER, MISSION VALLEY OUTPATIENT SURGERY CENTER | 261158246 - (CA) POWAY CA MULTI-SPECIALTY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $2859.00 | 1790241073 - HSS PALM BEACH AMBULATORY SURGERY CENTER, LLC | 301015589 - (FL) HSS PALM BEACH AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $916.00 | 1619065273 - SHENANDOAH TX ENDOSCOPY ASC LLC, WOODLANDS ENDOSCOPY CENTER | 205301383 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $2621.00 | 1366515504 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC, THE ENDOSCOPY & COLONOSCOPY CENTER | 205227186 - (MO) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1100.00 | 1952408783 - SHADYSIDE SURGI-CENTER, INC. | 251707086 - (PA) SHADYSIDE SURGICENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21125 | $1450.00 | 1598339392 - COPPER CITY SURGERY CENTER, PLLC | 831039743 - (MT) COPPER CITY SURGERY CENTER PLLC | MT | 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 21125 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21125 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 21125 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) |
| 21125-CPT | High | Augmentation, Mandibular Body Or Angle; Prosthetic Material -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 21125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21125 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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