CPT 21175 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 • 22 - Increased Procedural Services • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21175 |
National average reimbursement for CPT 21175 by major payers:
$2,625.21
$2,987.58
$3,154.38
$3,692.54
| 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 21175 | ||||||
United | 21175 | $21412.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $3886.38 | 1629125679 - OLUBUNMI ADEGBOYEGA | 350593390 - DEACONESS HOSPITAL INC | KY | Hospitalist Physician (208M00000X) |
United | 21175 | $5020.00 | 1548203888 - NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC, THE ORTHOPEDIC SURGERY CENTER OF ARIZONA | 202684773 - (AZ) NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $3073.00 | 1689149601 - ATLANTA PREMIER FOOT AND ANKLE SURGERY | 825318197 - (GA) ATLANTA PREMIER FOOT AND ANKLE SURGERY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $1127.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $2430.00 | 1306249453 - MARK FROMER, LLC, EYE SURGERY CENTERS OF NEW YORK | 274212773 - (NY) MARK FROMER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $4473.00 | 1821485442 - ALLEGHENY HEALTH NETWORK SURGERY CENTER | 473690355 - (PA) ALLEGHENY HEALTH NETWORK SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $1273.00 | 1245580711 - AMSTERDAM REC LLC, MOHAWK VALLEY EYE SURGERY CENTER | 453808566 - (NY) AMSTERDAM REC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $1785.64 | 1770863342 - LINDSEY BOWERS | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 21175 | $2485.00 | 1235551052 - LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC | 454714972 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $3834.00 | 1326557653 - SJ EAST CAMPUS ASC, LLC, DENVER SURGERY CENTER | 821485491 - (CO) SJ EAST CAMPUS ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $1376.00 | 1396897260 - LITTLE ROCK FERTILITY CENTER | 861078562 - (AR) LITTLE ROCK FERTILITY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $4603.00 | 1306135298 - DMG PAIN MANAGEMENT SURGERY CENTER, LLC | 271322187 - (IL) DMG PAIN MANAGEMENT SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $772.00 | 1487651956 - TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC, TRI-STATE DIGESTIVE DISORDER CENTER | 611192347 - (KY) TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21175 | $1284.00 | 1306924170 - DELMAR SURGICAL CENTER LLC | 621717312 - (MD) DELMAR SURGICAL 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 21175 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21175 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 21175 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 |
|---|---|---|
| 21172-CPT | High | Reconstruction Superior-Lateral Orbital Rim And Lower Forehead, Advancement Or Alteration, With Or Without Grafts (Includes Obtaining Autografts) |
| 21175-CPT | High | Reconstruction, Bifrontal, Superior-Lateral Orbital Rims And Lower Forehead, Advancement Or Alteration (Eg, Plagiocephaly, Trigonocephaly, Brachycephaly), With Or Without Grafts (Includes Obtaining Autografts) |
| 21179-CPT | High | Recon All/Maj Forehead/Rim W/Allograft/P |
| 21180-CPT | High | Recon All/Maj Forehead W/Autograft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21175. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21175 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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