CPT 21184 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 |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 78 - Return to OR - related procedure • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21184 |
National average reimbursement for CPT 21184 by major payers:
$3,127.01
$3,331.84
$3,337.72
$4,094.20
| 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 21184 | ||||||
United | 21184 | $3003.00 | 1992759930 - IDAHO SURGICENTER INC, IDAHO SURGICENTER SOUTH | 200049792 - (ID) IDAHO SURGICENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $638.00 | 1083060107 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $1635.00 | 1376616060 - NORTHSHORE SURGICAL CENTER, LLC | 202339324 - (LA) NORTHSHORE SURGICAL CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $5249.00 | 1750565594 - PEDIATRIC SURGERY CENTER -ODESSA, LLC | 651274446 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $2997.00 | 1942207196 - GRAND VALLEY SURGICAL CENTER, LLC | 841505075 - (CO) GRAND VALLEY SURGICAL CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $3000.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $3180.00 | 1275719981 - SURGERY CENTER OF KEY WEST LLC | 205854803 - (FL) SURGERY CENTER OF KEY WEST LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $1966.00 | 1013222926 - CARLIN VISION SURGERY CENTER LLC | 272799561 - (GA) CARLIN VISION SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $3365.00 | 1073613162 - ROCKY MOUNTAIN SURGERY CENTER LLC | 870699657 - (CO) ROCKY MOUNTAIN SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $4757.00 | 1700888658 - WESTON OUTPATIENT SURGICAL CENTER LTD, WESTON OUTPATIENT SURGICAL CENTER | 650930629 - (FL) WESTON OUTPATIENT SURGICAL CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $4800.00 | 1477792828 - PRECISION SURGICENTER LLC | 262185162 - (CA) PRECISION SURGICENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $2470.00 | 1710038534 - OUTPATIENT SURGICAL SPECIALTIES CENTER, LLC | 205596163 - (NE) OUTPATIENT SURGICAL SPECIALTIES CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $2600.00 | 1093766735 - TAMPA BAY SURGERY CENTER ASSOCIATES,LTD | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $10317.00 | 1063659605 - HOWARD COMMUNITY SURGERY CENTER LLC | 352118748 - (IN) HOWARD COMMUNITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21184 | $2576.00 | 1215126438 - THE ARCADIA CA ENDOSCOPY ASC LP, VALLEY DIGESTIVE HEALTH CENTER | 204484163 | 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 21184 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21184 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 21184 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 |
| 21184-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 Greater Than 80 Sq Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21184. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21184 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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