CPT 21179 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 • AS - PA/NP/CNS assistant at surgery • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21179 |
National average reimbursement for CPT 21179 by major payers:
$2,002.76
$2,030.22
$2,132.02
$2,514.17
| 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 21179 | ||||||
United | 21179 | $2412.00 | 1023570488 - SIGHT PARTNERS, LLC, NORTHWEST EYE SURGEONS | 833467355 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $4000.00 | 1356969703 - VASCULAR LABS OF THE ROCKIES ASC, LLC | 850780051 - (CO) VASCULAR LABS OF THE ROCKIES ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $742.00 | 1023507183 - SOUTH PERRY ENDOSCOPY PLLC | 462792041 - (WA) SOUTH PERRY ENDOSCOPY PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $853.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $8238.00 | 1104883784 - FORT WORTH ENDOSCOPY CENTERS, LLC, FORT WORTH ENDOSCOPY CENTER | 770368346 - (TX) FORT WORTH ENDOSCOPY CENTERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $2653.00 | 1174005235 - IDAHO FALLS ASC | 823089090 - (ID) IDAHO FALLS ASC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $5249.00 | 1306843222 - ST. JOSEPH'S OUTPATIENT SURGERY CENTER, LLC | 562332449 - (AZ) ST JOSEPHS OUTPATIENT SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $2000.00 | 1396238010 - WICHITA NEPHROLOGY GROUP, PA, REVASK SURGERY CENTER LLC | 481080103 - (KS) WICHITA NEPHROLOGY GROUP, P.A. | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $5354.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $2790.00 | 1578918124 - CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | 811657416 - (ND) CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $5922.00 | 1811318785 - CONNECTICUT ORTHOPAEDIC SPECIALISTS OUTPATIENT SURGICAL CENTER LLC | 462819773 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $5249.00 | 1528077658 - PRINCE WILLIAM AMBULATORY SURGERY CENTER, LLC, PRINCE WILLIAM SURGERY CENTER | 770594498 - (VA) PRINCE WILLIAM AMBULATORY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $5433.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $7391.00 | 1316900830 - BAYONET POINT SURGERY CENTER LTD | 200670560 - (FL) BAYONET POINT SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21179 | $2693.00 | 1407004534 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY 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 21179 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21179 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 21179 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 21179. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21179 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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