CPT 21188 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 • 58 - Staged or related procedure during postoperative period • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21188 |
National average reimbursement for CPT 21188 by major payers:
$1,964.64
$2,176.28
$2,217.26
$2,688.85
| 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 21188 | ||||||
United | 21188 | $1090.00 | 1073845087 - EYE SURGERY CENTERS OF ARIZONA, LLC, EYE SURGERY AT THE BILTMORE, LLC | 271798256 - (AZ) EYE SURGERY CENTERS OF ARIZONA 401(K) PROFIT SHARING PLAN & TRUST | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $2600.00 | 1508437385 - SPEEDWAY SURGICAL SPECIALISTS, LLC | 852710010 - (AZ) SPEEDWAY SURGICAL SPECIALISTS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $2150.00 | 1164930731 - REMBRANDT OUTPATIENT SURGERY CENTER PLLC, REMBRANDT OUTPATIENT SURGERY CENTER | 822368976 - (AZ) REMBRANDT OUTPATIENT SURGERY CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $3407.00 | 1700419678 - METHODIST MANSFIELD AMBULATORY SURGERY CENTER, LLC | 260869371 - (TX) METHODIST MANSFIELD AMBULATORY SURGERY CENTER LL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $1783.00 | 1740287168 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $1773.00 | 1366422370 - URLOGY AMBULATORY SURGERY CENTER LLC, WOLF RIVER SURGERY CENTER | 621828958 - (TN) URLOGY AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $2666.00 | 1730374307 - NORTHVIEW ORTHOPAEDIC SURGERY CENTER, P.C. | 261245423 - (GA) NORTHVIEW ORTHOPAEDIC SURGERY CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $10546.00 | 1538245717 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $2400.00 | 1497367262 - SNKS ENTERPRISES LLC, SOL VALLEY SURGERY CENTER | 364932587 - (AZ) SNKS ENTERPRISES LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $1355.00 | 1669481255 - SURGERY CENTER OF CULLMAN LLC, HEALTHSOUTH/WOODLANDS SURGERY CENTER OF CULLMAN, LLC | 203489003 - (AL) SURGERY CENTER OF CULLMAN LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $5354.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $730.00 | 1750331500 - ARMENIA AMBULATORY SURGERY CENTER LLC, MEDICAL VILLAGE SURGICAL CENTER | 270946506 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $1589.00 | 1154449643 - AUGUSTA EYE SURGERY, LLC | 205644814 - (GA) AUGUSTA EYE SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $1401.00 | 1487094058 - COMPREHENSIVE PAIN CENTER FOR SURGERY, FOUNTAINS SPECIALTY SURGICAL CENTER | 460896509 - (MS) COMPREHENSIVE PAIN CENTER FOR SURGERY | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21188 | $6506.00 | 1023191822 - SANTA BARBARA SURGERY CENTER LP | 371846158 | 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 21188 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21188 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 21188 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 |
|---|---|---|
| 21145-CPT | High | Reconstruction Midface, Lefort I; Single Piece Segment Movement In Any Direction Requiring Bone Grafts -Commercial Rn Review>=8/1/2001: Medicaid Rn Review=8/1/2001-9/30/2020 |
| 21146-CPT | High | Reconstruction Midface, Lefort I; 2 Pieces, Segment Movement In Any Direction, Requiring Bone Grafts (Includes Obtaining Autografts) (Eg, Ungrafted Unilateral Alveolar Cleft) |
| 21147-CPT | High | Reconstruction Midface, Lefort I; 3 Or More Pieces, Segment Movement In Any Direction, Requiring Bone Grafts (Includes Obtaining Autografts) (Eg, Ungrafted Bilateral Alveolar Cleft Or Multiple Osteotomies) |
| 21188-CPT | High | Reconstruction Midface, Osteotomies & Bone Grafts -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21188. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21188 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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