CPT 21147 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 • 11 - Office |
| Common Modifiers | • None • 80 - Assistant surgeon • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21147 |
National average reimbursement for CPT 21147 by major payers:
$2,132.48
$2,264.90
$2,372.12
$2,840.72
| 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 21147 | ||||||
United | 21147 | $2014.00 | 1457465403 - VENTURE AMBULATORY SURGERY CENTER | 743257508 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $5630.00 | 1902851009 - 90210 SURGERY MEDICAL CENTER, LLC, 90210 SURGERY MEDICAL CENTER AT LINDEN | 134341801 - (CA) 90210 SURGERY MEDICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $5354.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $1014.00 | 1528032711 - COLUMBIA ENDOSCOPY CENTER, LLC | 710923725 - (MO) COLUMBIA ENDOSCOPY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $4100.00 | 1972153997 - EASTERN PENNSYLVANIA ENDOSCOPY CENTER, LLC | 842257961 - (PA) EASTERN PENNSYLVANIA ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $6775.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $4068.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $660.00 | 1013999580 - INTEG HEALTH SYSTEM, P.C., BLOOMINGTON SURGERY CENTER | 352045236 - (IN) INTEG HEALTH SYSTEM PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $1450.00 | 1275519373 - PROGRESSIVE LASER SURGICAL INSTITUTE LTD | 200172711 - (PA) PROGRESSIVE LASER SURGICAL INSTITUTE LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $2369.00 | 1730409400 - EYE BONE, LLC, CHARDON SURGERY CENTER | 204691851 - (OH) EYE BONE, LLC DBA CHARDON SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $6286.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $28000.00 | 1720127483 - FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | 311728173 - (CO) FRONT RANGE ORTHOPEDIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $903.00 | 1073588356 - DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA, LLC | 201456252 - (AZ) DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $658.00 | 1689608697 - ADVANCED COLON CARE INC, SHORELINE COLONOSCOPY SUITES | 61562707 - (CT) ADVANCED COLON CARE INC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21147 | $2169.00 | 1619469244 - RUSH OAK BROOK SURGERY CENTER, LLC | 371832312 - (IL) RUSH OAK BROOK SURGERY CENTER, LLC | IL | 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 21147 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21147 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 21147 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 | 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 | 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) |
| 21150-CPT | High | Reconstruction Midface, Lefort Ii; Anterior Intrusion -Commercial Rn Review>=8/1/2001: Medicaid Rn Review=8/1/2001-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21147. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21147 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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