CPT 21181 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • SG - Scene to Hospital ESRD facility • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21181 |
National average reimbursement for CPT 21181 by major payers:
$890.81
$986.74
$1,004.61
$1,231.21
| 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 21181 | ||||||
United | 21181 | $2243.00 | 1356572465 - ORCHARD CREEK SURGERY CENTER, ORCHARD CREEK SURGERY CENTER | 770498874 - (CA) ORCHARD CREEK SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $1173.00 | 1174258107 - FW SPECIALTY SURGICARE, LLC | 854261198 - (TX) FW SPECIALTY SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $1834.00 | 1861497380 - NORTHEAST NEBRASKA SURGERY CENTER LLC, FAITH REGIONAL SURGERY CENTER | 470819088 - (NE) NORTHEAST NEBRASKA SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $465.00 | 1487871331 - GYNEMED SURGICAL CENTER | 521921544 - (MD) GYNEMED SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $3871.00 | 1639850415 - MEDICAL CITY SURGERY CENTER OF ALLEN, LLC | 932106228 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $3006.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $559.00 | 1639203888 - VALLEY MEDICAL GROUP, P.C., VALLEY MEDICAL GROUP AMBULATORY SURGERY & PROCEDURES CENTER | 42945394 - (MA) VALLEY MEDICAL GROUP, P.C. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $3599.00 | 1316395270 - IRVINE SURGICAL PARTNERS LLC | 812776218 - (CA) IRVINE SURGICAL PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $859.00 | 1306877261 - NORTHEAST ALABAMA EYE SURGERY CENTER, NORTHEAST AL EYE SURGERY | 631277373 - (AL) NORTHEAST ALABAMA EYE SURGERY CENTER | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $1725.00 | 1922211192 - VOORHEES SURGERY CENTER, LLC | 651203770 - (NJ) VOORHEES SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $950.00 | 1669772893 - ADVANCED EYE SURGERY CENTER, L.L.C. | 273717607 - (KS) ADVANCED EYE SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $3730.00 | 1902851009 - 90210 SURGERY MEDICAL CENTER, LLC, 90210 SURGERY MEDICAL CENTER AT LINDEN | 134341801 - (CA) 90210 SURGERY MEDICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $544.00 | 1568466209 - BAYVIEW MEDICAL CENTER, INC, LMC AMBULATORY SURGERY CENTER | 541593723 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $1066.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21181 | $1925.00 | 1770072803 - PACIFIC VASCUCARE SURGERY CENTER | 823288521 - (CA) PACIFIC VASCUCARE SURGERY CENTER | CA | 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 21181 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21181 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 21181 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 |
|---|---|---|
| 21179-CPT | High | Recon All/Maj Forehead/Rim W/Allograft/P |
| 21180-CPT | High | Recon All/Maj Forehead W/Autograft |
| 21181-CPT | Moderate | Rem Contour Benign Tumor Cranial Bones |
| 21182-CPT | High | Reconstruction Of Orbital Walls, Rims, Forehead, Nasoethmoid Complex Following Intra- And Extracranial Excision Of Benign Tumor Of Cranial Bone (Eg, Fibrous Dysplasia), With Multiple Autografts (Includes Obtaining Grafts); Total Area Of Bone Grafting Less Than 40 S |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21181. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21181 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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