CPT 21159 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 • 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 |
National average reimbursement for CPT 21159 by major payers:
$3,341.22
$3,571.13
$3,549.64
$4,378.70
| 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 21159 | ||||||
United | 21159 | $885.00 | 1073588356 - DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA, LLC | 201456252 - (AZ) DIGESTIVE HEALTH SPECIALISTS ENDOSCOPY CENTER ARIZONA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $3864.00 | 1770731853 - SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER LENEXA | 364634843 - (KS) SHAWNEE MISSION PRAIRIE STAR SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $5745.00 | 1497776553 - ALPINE SURGERY CENTER LLC | 204038061 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $5779.00 | 1699738112 - NORTH AUSTIN SURGERY CENTER, L.P. | 200648730 - (TX) NORTH AUSTIN SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $1500.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $3164.00 | 1184978637 - INLAND VALLEY SURGERY CENTER, LLC | 263900973 - (CA) INLAND VALLEY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $5910.00 | 1033190566 - NORTHERN INDIANA AMBULATORY SURGERY CENTER, RIVERPOINTE SURGERY CENTER | 351994079 - NORTHERN INDIANA AMBULATORY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $2706.00 | 1861743601 - FLUSHING ENDOSCOPY CENTER, LLC | 274675522 - (NY) FLUSHING ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $4365.00 | 1225221435 - GALLERIA SURGERY CENTER LLC | 731713874 - (MD) GALLERIA SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $1308.00 | 1295798346 - SUNRISE FLAMINGO SURGERY CENTER, LLC, FLAMINGO SURGERY CENTER | 621679326 - (NV) SUNRISE FLAMINGO SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $6150.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $816.00 | 1780658062 - GLEN ENDOSCOPY CENTER, LLC | 364486546 - (IL) THE GLEN ENDOSCOPY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $863.00 | 1962463133 - SURGICAL CENTERS OF MICHIGAN, LLC. | 383580697 - (MI) SURGICAL CENTERS OF MICHIGAN LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $3973.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21159 | $2762.00 | 1164007068 - SW HEALTH LP | 853293126 - (TX) SW HEALTH LP | TX | 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 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 |
|---|---|---|
| 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 |
| 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 |
| 21159-CPT | High | Reconstruction Midface, Lefort Iii (Extra And Intracranial) With Forehead Advancement (Eg, Mono Bloc), Requiring Bone Grafts (Includes Obtaining Autografts); Without 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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