CPT 21137 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 21137 by major payers:
$924.44
$1,000.98
$1,057.78
$1,245.56
| 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 21137 | ||||||
United | 21137 | $2353.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1180.00 | 1487612024 - QUAD CITY AMBULATORY SURGERY CENTER LLC | 364471903 - (IL) QUAD CITY AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1482.00 | 1841884731 - EYE MD OF NICEVILLE SURGERY LLC | 862163581 - (FL) EYE MD OF NICEVILLE SURGERY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1090.00 | 1053039883 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1136.00 | 1689652638 - INSTITUTE OF ORTHOPAEDIC SURGERY LLC | 731657293 - (NV) INSTITUTE OF ORTHOPAEDIC SURGERY LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1550.00 | 1356798854 - MID CITIES ASC, LP | 811663790 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1080.00 | 1346698602 - MARION EYE SURGERY CENTER LLC | 263644916 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $3227.00 | 1073816690 - PENN STATE HERSHEY ENDOSCOPY CENTER LLC | 274000022 - (PA) PENN STATE HERSHEY ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $2250.00 | 1003965328 - PACIFIC HEIGHTS SURGERY CENTER OF SAN FRANCISCO LP | 522380476 - (CA) PACIFIC HEIGHTS SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $900.00 | 1841347143 - RUXTON SURGICENTER LLC | 522095835 - (MD) RUXTON SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1700.00 | 1528480076 - SOUTH ATLANTA AMBULATORY SURGICAL CENTER, LLC | 462848445 - (GA) SOUTH ATLANTA AMBULATORY SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1840.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1326.00 | 1851678981 - RIDGECREST SPECIALTY SURGERY CENTER, A PROFESSIONAL CORPORATION | 453602999 - (CA) RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $950.00 | 1184784209 - AMERICAN SURGICAL CENTERS II, LLC, AMERICAN SURGICAL CENTERS | 383486345 - (MI) AMERICAN SURGICAL CENTERS II LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21137 | $1200.00 | 1023570488 - SIGHT PARTNERS, LLC, NORTHWEST EYE SURGEONS | 833467355 | 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 21137 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21137 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 21137 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 |
|---|---|---|
| 21137-CPT | Moderate | Reduction Forehead; Contouring Only- Rn Review <9/10/2021 |
| 21138-CPT | High | Reduction Forehead; Contouring And Application Of Prosthetic Material Or Bone Graft (Includes Obtaining Autograft) |
| 21139-CPT | High | Reduction Forehead; Contouring & Setback Of Anterior Frontal Sinus Wall- Rn Review <9/10/2021 |
| 21141-CPT | High | Reconstruction Midface, Lefort I; Single Piece Segment Movement In Any Direction Without Bone Graft -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 21137. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21137 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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