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 | Repair, Revision, and/or Reconstruction Procedures on the Head Surgical Procedures on the Head |
| 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 |
| Medicare Fee Schedule | View Medicare rates for 21151 |
National average reimbursement for CPT 21151 by major payers:
$2,262.99
$2,532.90
$2,528.60
$3,035.44
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 21151 | $1584.00 | 1316375884 - OXON HILL UROLOGY SURGERY CENTER PC | 463746777 - (MD) OXON HILL UROLOGY SURGERY CENTER PC | MD | 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 | $4335.00 | 1043746555 - OVERLAND PARK SURGICAL SUITES, LLC | 814367607 - (KS) OVERLAND PARK SURGICAL SUITES LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $6506.00 | 1215091087 - CORPUS CHRISTI SURGICARE LTD, CHRISTUS SPOHN TEXAS ORTHOPEDIC CENTER OF EXCELLENCE | 753049514 - (TX) CORPUS CHRISTI SURGICARE LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $900.00 | 1992735286 - CASTLEMAN SURGERY CENTER, LLC, SOUTHGATE SURGERY CENTER | 383029505 - (MI) CASTLEMAN SURGERY CENTER LLC | MI | 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 | $1957.00 | 1750308763 - SURGICAL SPECIALTIES OF ARROYO GRANDE INC. | 770580453 - (CA) OAK PARK SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $5249.00 | 1992992994 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3398.00 | 1891286860 - SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | 825437441 - (GA) SANDY SPRINGS CENTER FOR UROLOGIC SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3927.00 | 1669415451 - BOUNTIFUL SURGERY CENTER LLC | 364581088 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3003.00 | 1497745178 - SURGERY CENTER, DBA SAWTOOTH SURGERY CENTER | 823348107 - (ID) SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3935.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $3650.00 | 1003965328 - PACIFIC HEIGHTS SURGERY CENTER OF SAN FRANCISCO LP | 522380476 - (CA) PACIFIC HEIGHTS SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $2848.00 | 1922664622 - PREMIER CARDIAC SURGERY CENTER, PLLC, PREMIER CARDIAC SURGERY CENTER, LLC | 824896471 - (IL) PREMIER CARDIAC SURGERY CENTER PLLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21151 | $5249.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | 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 Head Codes
The CPT 21151 code is part of the Repair, Revision, and/or Reconstruction Procedures on the Head services used for Surgical Procedures on the Head. 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 | 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 |
| 21150-CPT | High | Reconstruction Midface Lefort, Reconstruction Midface Lefort Ii Anterior Intrusion (Egtreacher-Collins Syndrome) Reconstructionmidface Lefort Ii Anterior Intrusion (Eg |
| 21151-CPT | High | Reconstruction Midface Lefort, Reconstruction Midface Lefort Ii Any Direction Requiring Bone Grafts (Includes Obtaining Autografts) Reconstruction Midface Lefort Ii Any Direction Requiring |
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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