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See a sample rate comparisonCPT 21175 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.
Reconstruct Orbit Forehead, Reconstruction Bifrontal Superior Lateral Orbital Rims And Lower Forehead Advancement Or Alteration Eg Plagiocephaly Trigonocephaly Brachycephaly With Or Without Grafts Includes Obtaining Autografts
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 21175 |
National average reimbursement for CPT 21175 by major payers:
$2,625.21
$2,987.58
$3,154.38
$3,609.45
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CPT 21175
5 of 25 sample ratesHigher to lower in this preview
Northshore Regional Medical Center Dba The Surgery Suite, The Surgery Suite
Ochsner Clinic Foundation
$21,412.00Published rateSt. Vincent'S Outpatient Surgery Services LLC
St Vincents Outpatient Surgery Services LLC
$4,123.00Published rateProffer Surgical Center, PLLC
Proffer Surgical Center PLLC
$2,800.00Published rateLindsey Bowers
Deaconess Hospital Inc
$1,785.64Published rateTri-State Gastroenterology Associates, Psc, Tri-State Digestive Disorder Center
Tri-State Gastroenterology Associates, Psc
$772.00Published rate
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See a sample payer proposalCPT 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-Latera, Reconstruction Superior-Lateral Orbital Rim And Lowerforehead Advancement Or Alteration With Or Without Grafts (Includes Obtaining Autografts) |
| 21175-CPT | High | Reconstruct Orbit Forehead, 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 | Reconstruct Entire Forehead, Reconstruction Entire Or Majority Of Forehead And/Or Supraorbital Rims; With Grafts (Allograft Or Prosthetic Material) |
| 21180-CPT | High | Reconstruct Entire Forehead, Reconstruction Entire Or Majority Of Forehead And/Or Supraorbital Rims; With Autograft (Includes Obtaining Grafts) |
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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