CPT 21151 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 22 - Increased Procedural Services • 80 - Assistant surgeon • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 21151 by major payers:
$2,262.99
$2,532.90
$2,528.60
$3,104.11
| 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 21151 | ||||||
United | 21151 | $5410.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $4764.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $5249.00 | 1538126362 - WINTER HAVEN AMBULATORY SURGICAL CENTER LLC | 593659906 - (FL) WINTER HAVEN AMBULATORY SURGICAL CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $5354.00 | 1811001860 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $786.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $2500.00 | 1235567264 - WENTWORTH SURGERY CENTER, LLC | 900975592 - (NH) WENTWORTH SURGERY CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $2928.00 | 1477625390 - CENTURY SURGICAL ASSOCIATES, INC | 473537670 | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3298.00 | 1417217183 - PAULSEN STREET SUGERY CENTER LLC | 824075002 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $900.00 | 1043396245 - WEST FLORIDA MEDICAL CENTER CLINIC PA, MEDICAL CENTER CLINIC AMBULATORY SURGICAL CENTER | 592193856 - (FL) WEST FLORIDA MEDICAL CENTER CLINIC, P.A. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $1030.00 | 1366032617 - EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER, LLC | 843673604 - (MA) EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $2689.00 | 1891722609 - EYE MDS OF PUGET SOUND PLLC, NARROWS EYE SURGERY CENTER | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $4335.00 | 1043746555 - OVERLAND PARK SURGICAL SUITES, LLC | 814367607 - (KS) OVERLAND PARK SURGICAL SUITES LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $1050.00 | 1912090218 - TULSA HAND SURGERY CENTER LLC | 731572055 - (OK) TULSA HAND SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3365.00 | 1871912485 - HEALTHONE RIDGE VIEW ENDOSCOPY CENTER, LLC, SOUTH DENVER ENDOSCOPY CENTER | 800688043 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $2500.00 | 1154590271 - UNITY SURGICAL CENTER, LLC, UNITY SURGICAL CENTER | 352099067 - (IN) UNITY SURGICAL CENTER LLC | IN | 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 21151 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21151 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 21151 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 |
|---|---|---|
| 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 |
| 21151-CPT | High | Reconstruction Midface, Lefort Ii; Any Direction, Requiring Bone Grafts -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 21151. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21151 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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