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See a sample rate comparisonCPT 21145 Fee Schedule
Last Verified: October 2026
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.
Reconstruction Midface, Lefort I; Single Piece Segment Movement In Any Direction Requiring Bone Grafts -Commercial Rn Review>=8/1/2001: Medicaid Rn Review=8/1/2001-9/30/2020
| 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 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21145 |
| Medicaid Fee Schedule | View Medicaid rates for 21145 |
National average reimbursement for CPT 21145 by major payers:
$1,950.80
$2,078.21
$2,225.76
$2,541.85
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CPT 21145
5 of 25 sample ratesHigher to lower in this preview
Hhc Southington Surgery Center, LLC, Cheshire Surgery Center
Hhc Southington Surgery Center, LLC
$5,922.00Published rateRome Orthopaedic Clinic Asc, Inc.
Rome Orthopaedic Clinic Asc Inc
$3,625.00Published rateShriners Hospitals For Children, Shriners For Children Ambulatory Surgical Center
Shriners Hospitals For Children
$2,827.00Published rateSkyline Surgery Center, LLC, Skyline Eye Surgery Center
Skyline Surgery Center LLC
$1,900.00Published rateEndoscopic Ambulatory Specialty Center Of Bay Ridge Inc
Endoscopic Ambulatory Specialty Center Of Bay Ridge, Inc.
$1,000.00Published rate
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See a sample payer proposalCPT 21145 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21145 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 21145 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 |
|---|---|---|
| 21145-CPT | High | Reconstruction Midface, Lefort I; Single Piece Segment Movement In Any Direction Requiring Bone Grafts -Commercial Rn Review>=8/1/2001: Medicaid Rn Review=8/1/2001-9/30/2020 |
| 21146-CPT | High | Rcnstj Mdfc Lefort I 2 W/Grf, Reconstruction Midface Lefort I; 2 Pieces Segment Movement In Any Direction Requiring Bone Grafts (Includes Obtaining Autografts) (Eg Ungrafted Unilateral Alveolar Cleft) |
| 21147-CPT | High | Lefort I 3 Piece W Graft, Reconstruction Midface Lefort I 3 Or More Pieces Segment Movement In Any Direction Requiring Bone Grafts Includes Obtaining Autografts Eg Ungrafted Bilateral Alveolar Cleft Or Multiple Osteotomies |
| 21188-CPT | High | Surgery To Reshape The Face, Surgery To Reconstruct The Bones In The Center Of The Face. The Procedure Corrects Abnormalities Of The Head And Face. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21145. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21145 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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