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See a sample rate comparisonCPT 21159 Fee Schedule
Last Verified: October 2026
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.
Lefort Iii W Fhdw O Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts Without Lefort I
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None 62 - Co-Surgeons AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21159 |
| Medicaid Fee Schedule | View Medicaid rates for 21159 |
National average reimbursement for CPT 21159 by major payers:
$3,341.22
$3,571.13
$3,549.64
$4,284.49
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CPT 21159
5 of 25 sample ratesHigher to lower in this preview
Midtown Surgery Center, LLC
$6,150.00Published rateEast Portland Surgery Center LLC
East Portland Surgery Center, LLC
$5,128.00Published rateInland Valley Surgery Center, LLC
Inland Valley Surgery Center LLC
$3,164.00Published rateEyes On Stark Surgery Center, LLC, Vista Surgical Center
Eyes On Stark Surgery Center, LLC Dba Vista Surgical Center
$1,900.00Published rateGlen Endoscopy Center, LLC
The Glen Endoscopy Center, LLC
$816.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21159 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21159 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 21159 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 |
|---|---|---|
| 21154-CPT | High | Rcnstj Mdfc Lefort Iii W/O I, Reconstruction Midface Lefort Iii (Extracranial) Any Type Requiring Bone Grafts (Includes Obtaining Autografts); Without Lefort I |
| 21155-CPT | High | Reconstruction Midface Lefort, Reconstruction Midface Lefort Iii (Extracranial)Any Typerequiring Bone Grafts (Includes Obtainin G Autografts) With Lefort I |
| 21159-CPT | High | Lefort Iii W Fhdw O Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts Without Lefort I |
| 21160-CPT | High | Lefort Iii W Fhd W Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts With Lefort I |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21159. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21159 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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