CPT 21142 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 • 80 - Assistant surgeon • 52 - Reduced Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21142 |
National average reimbursement for CPT 21142 by major payers:
$1,857.86
$1,846.09
$1,974.19
$2,308.98
| 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 21142 | ||||||
United | 21142 | $6042.00 | 1336148360 - BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER, LLC, BOULDER SURGERY CENTER | 201391702 - (CO) BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $5354.00 | 1356307565 - AMBULATORY SURGICAL ASSOCIATES LLC, TULLAHOMA SURGERY CENTER | 61658016 - (TN) AMBULATORY SURGICAL ASSOCIATES LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $2415.00 | 1619998523 - UPSTATE SURGERY CENTER, LLC | 562186977 - (SC) UPSTATE SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $880.00 | 1962609560 - FRONT RANGE ENDOSCOPY CENTERS, LLC | 205008349 - (CO) FRONT RANGE ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $3003.00 | 1750386256 - PALOUSE SURGERY CENTER, LLC | 810593962 - (ID) PALOUSE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $3438.00 | 1811148869 - ENDOSCOPY CENTER OF THE ROCKIES LLC | 841562782 - (CO) ENDOSCOPY CENTER OF THE ROCKIES LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $5433.00 | 1114253093 - CRESCENT CITY SURGERY CENTER LLC | 271113561 - (IN) CRESCENT CITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $3000.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $1835.00 | 1073079596 - PREMIER GASTROENTEROLOGY ASSOCIATES PLLC, PREMIER SURGERY CENTER | 824134212 - (AR) PREMIER GASTROENTEROLOGY ASSOCIATES, PLLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $4234.00 | 1023420577 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $5433.00 | 1053376160 - SARASOTA SURGERY CENTER LTD | 203757623 - (FL) SURGERY CENTER AT UNIVERSITY PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $2310.00 | 1366884322 - INNOVATIONS SURGERY CENTER, PC | 461513141 - (MD) INNOVATIONS SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $930.00 | 1992777643 - CAPE CORAL FT MYERS ENDOSCOPY ASC LLC, GULF COAST ENDOSCOPY CENTER SOUTH | 621767599 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $586.00 | 1528035367 - EYE SURGERY CENTER OF WESTERN OHIO LLC, EYE SURGERY CENTER OF WESTERN OHIO | 311570796 - (OH) EYE SURGERY CENTER OF WESTERN OHIO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21142 | $1090.00 | 1760454557 - PHOENIX OPHTHALMOLOGY ASC LLC, ARIZONA OPHTHALMIC OUTPATIENT SURGERY | 621726788 - (AZ) PHOENIX OPHTHALMOLOGY ASC LLC | 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 21142 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21142 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 21142 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 |
|---|---|---|
| 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 |
| 21142-CPT | High | Reconstruction Midface, Lefort I; 2 Pieces 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 21142. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21142 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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