CPT 21138 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • KX - Requirements specified in the medical policy have been met |
| Complexity Level | High |
National average reimbursement for CPT 21138 by major payers:
$1,166.03
$1,225.47
$1,366.37
$1,520.94
| 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 21138 | ||||||
United | 21138 | $638.00 | 1083060107 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $1230.00 | 1326170036 - TAMPA BAY EYE SURGERY CENTER, LLC | 273286942 - (FL) TAMPA BAY EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $5249.00 | 1316947609 - AMARILLO ENDOSCOPY CENTER, LP | 752893120 - (TX) AMARILLO ENDOSCOPY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $2625.00 | 1144590332 - HEALTHCARE PARTNERS ASC-LB, LLC, DAVITA MEDICAL ASC | 954628842 - (CA) HEALTHCARE PARTNERS ASCLB LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $3453.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $5020.00 | 1902807159 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF SCOTTSDALE | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $3150.00 | 1649350844 - NORTHERN PLAINS SURGERY CENTER LLC | 450447247 - (ND) NORTHERN PLAINS SURGERY CENTER, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $5249.00 | 1972886190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $1633.00 | 1336138635 - EYE SURGICAL SPECIALISTS OF NEW JERSEY, SURGERY CENTER OF CENTRAL NEW JERSEY | 223411416 - (NJ) EYE SURGICAL SPECIALISTS OF NEW JERSEY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $3810.00 | 1770112617 - UCHEALTH AMBULATORY SURGERY CENTERS, UCHEALTH CHERRY CREEK NORTH SURGERY CENTER | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $5249.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $4210.00 | 1689666596 - MENOMONEE FALLS AMBULATORY SURGERY CENTER, LLC | 391745697 - (WI) MENOMONEE FALLS AMBULATORY SURGERY CENTER | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $5354.00 | 1437419660 - ADVANCED SURGERY CENTER OF METAIRIE LLC | 453386956 - (LA) ADVANCED SURGERY CENTER OF METAIRIE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $2354.00 | 1679585772 - MEDICAL CENTER ENDOSCOPY, LLC, MEDICAL CENTER ENDOSCOPY | 760550704 - (TX) MEDICAL CENTER ENDOSCOPY, LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21138 | $848.00 | 1194790808 - DIGESTIVE ENDOSCOPY CENTER LLC | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 21138 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21138 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 21138 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 21138. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21138 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21138) and we'll show you how you compare in 15 minutes or less.