CPT 21154 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 62 - Co-Surgeons • 22 - Increased Procedural Services |
| Complexity Level | High |
National average reimbursement for CPT 21154 by major payers:
$2,453.18
$2,709.96
$2,732.81
$3,329.46
| 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 21154 | ||||||
United | 21154 | $2357.00 | 1174520191 - AESTHETIC SURGERY CENTER OF EUGENE INC | 931320547 - (OR) AESTHETIC SURGERY CENTER OF EUGENE INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $625.00 | 1639105455 - ENDOSURG OUTPATIENT CENTER LLC | 593678998 - (FL) ENDOSURG OUTPATIENT CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $1444.00 | 1437517745 - PREMIER AMBULATORY SURGERY CENTER | 475603095 - (NY) PREMIER AMBULATORY SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $1509.00 | 1649911470 - ST. PETERSBURG OUTPATIENT SURGERY CENTER, LLC | 842007777 - (FL) ST PETERSBURG OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $703.00 | 1538231956 - COASTAL MEDICAL CENTER LLC | 650956639 - (FL) COASTAL MEDICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $2109.00 | 1972208379 - HIGH RESORT EYE SURGERY CENTER LLC | 923159505 - (NM) HIGH RESORT EYE SURGERY CENTER LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $5433.00 | 1275292229 - SCOTTSDALE ENDOSCOPY ASC LLC | 873952617 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $6506.00 | 1891450805 - NORTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS LLC | 364920288 - (CO) NORTH DENVER MUSCULOSKELETAL SURGICAL PARTNERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $2800.00 | 1033773023 - VISION PARK SURGERY CENTER, LLC | 832719581 - (TX) VISION PARK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $3700.00 | 1043679509 - NORTHPOINTE SURGICAL SUITES, LLC | 472788542 - (OH) NORTHPOINTE SURGICAL SUITES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $2610.00 | 1023001377 - SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC | 371377370 - (IL) SOUTHERN ILLINOIS ORTHOPEDIC CENTERLLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $963.00 | 1639242506 - RENAL INTERVENTION CENTER, LLC | 371387622 - (IL) RENAL INTERVENTION CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $4704.00 | 1760912554 - BAYLOR SURGICARE AT BAYLOR PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE AT PLANO ALLIANCE | 813127185 - (TX) BAYLOR SURGICARE AT BAYLOR PLANO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $2700.00 | 1558327338 - DANBURY SURGICAL CENTER LP, SURGICAL CENTER OF RIDGEFIELD | 631263704 - (CT) DANBURY SURGICAL CENTER LP | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21154 | $2550.00 | 1194209437 - PRECISION SURGICAL CENTER OF NORTHWEST ARKANSAS, LLC | 830659399 - (AR) PRECISION SURGICAL CENTER OF NORTHWEST ARKANSAS LLC | AR | 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 21154 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21154 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 21154 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) |
| 21150-CPT | High | Reconstruction Midface, Lefort Ii; Anterior Intrusion -Commercial Rn Review>=8/1/2001: Medicaid Rn Review=8/1/2001-9/30/2020 |
| 21154-CPT | High | Reconstruction Midface, Lefort Iii, Any Type, Requiring Bone Grafts; Without Lefort I -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 21154. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21154 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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