CPT 21155 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 • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21155 |
National average reimbursement for CPT 21155 by major payers:
$2,912.01
$2,988.42
$2,963.76
$3,666.63
| 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 21155 | ||||||
United | 21155 | $10859.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $1361.00 | 1679523351 - SURGERY CENTER OF PORT CHARLOTTE LTD | 201327093 - (FL) SURGERY CENTER OF PORT CHARLOTTE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $7770.00 | 1497312540 - MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC | 384114079 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $4014.00 | 1174185649 - PISA ASC HOLDCO LLC, PAIN INSTITUTE OF SOUTHERN ARIZONA PROCEDURE CENTER | 831944129 - (AZ) PISA ASC HOLDCO LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $5249.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $7124.00 | 1164017778 - MEDICAL CITY SURGERY CENTER OF ALLIANCE, LLC | 822480225 - (TX) MEDICAL CITY SURGERY CENTER OF ALLIANCE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $1201.00 | 1811933179 - KALAMAZOO ENDO CENTER LLC | 201582174 - (MI) KALAMAZOO ENDO CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $2500.00 | 1295855948 - MAINE EYE CENTER, PA | 10329291 - (ME) MAINE EYE CENTER | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $1937.00 | 1316290380 - ATHENS SURGERY CENTER LLC, THE SURGERY CENTER OF ATHENS | 800812776 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $3580.00 | 1912600826 - SURGICAL CENTER OF TVH | 882585662 - (ID) SURGICAL CENTER OF TVH | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $2200.00 | 1376161117 - ACCESS CARE PHYSICIANS OF NJ LLC | 203639484 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $4405.00 | 1619333010 - ORANGE ASC, LTD, ORTHOPEDIC ONE SURGERY CENTER AT EASTON | 464700223 - (OH) ORANGE ASC LTD DBA ORTHOPEDIC ONE SURGERY CENTER AT EASTON | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $3800.00 | 1245207687 - CDI TWIN CITIES ASC LLC, RAYUS TWIN CITIES ASC | 820565885 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $2354.00 | 1710151063 - HENDI AMBULATORY SURGERY CENTER, PC | 262238944 - (MD) HENDI AMBULATORY SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21155 | $5249.00 | 1184687386 - DIGESTIVECARE, LLC, DIGESTIVECARE ENDOSCOPY UNIT | 311108485 - (OH) DIGESTIVE CARE, INC. | OH | 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 21155 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21155 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 21155 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 |
| 21155-CPT | High | Reconstruction Midface, Lefort Iii, Any Type, Requiring Bone Grafts; With 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 21155. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21155 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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