CPT 21180 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 21180 |
National average reimbursement for CPT 21180 by major payers:
$2,111.59
$2,260.78
$2,386.93
$2,799.46
| 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 21180 | ||||||
United | 21180 | $1159.00 | 1679566582 - FOREST CANYON ENDOSCOPY & SURGERY CTR PC | 460504121 - (AZ) FOREST CANYON ENDOSCOPY & SURGERY CENTER, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $2100.00 | 1285825075 - SUNNYSIDE SURGERY CENTER, LLC | 201164055 - (ID) SUNNYSIDE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $2619.00 | 1992752794 - SIERRA EYE AMBULATORY SURGERY CENTER, LLC | 770509889 - (CA) SIERRA EYE AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $4472.00 | 1649520057 - MUNSTER SPECIALTY SURGERY CENTER, LLC, MUNSTER SPECIALTY SURGERY CENTER | 454918544 - (IN) MUNSTER SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $2310.00 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $4530.00 | 1407981327 - ARIA HEALTH TORRESDALE -SPU | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $4200.00 | 1427166990 - LOS ALTOS SURGERY CENTER LLC | 200864086 - (CA) LOS ALTOS | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $3050.00 | 1184699878 - NOC SURGERY CENTER LLC, LOC SURGERY CENTER | 470877119 - (NE) NOC SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $5433.00 | 1093985525 - SURGERY CENTER OF CORAL GABLES LLC, CORAL GABLES SURGERY CENTER | 204843518 - (FL) SURGERY CENTER OF CORAL GABLES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $2009.00 | 1043473390 - LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP | 952858745 - (CA) LAKEWOOD EYE PHYSICIANS & SURGEONS, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $5020.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $680.00 | 1417937756 - CLEVELAND ASC LLC, CLEVELAND SURGICAL SUITES | 621647411 - (OH) CLEVELAND ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $1787.00 | 1457379364 - JONESBORO SURGERY CENTER, LLC | 731589472 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $5249.00 | 1043605934 - SEASIDE SURGERY CENTER, LLC | 472399984 - (FL) SEASIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21180 | $1403.00 | 1447286562 - ANWAR EYE CENTER, INC | 550697745 - (WV) ANWAR EYE CENTER INC | WV | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 21180 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21180 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 21180 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 21180. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21180 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21180) and we'll show you how you compare in 15 minutes or less.