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See a sample rate comparisonCPT 21188 Fee Schedule
Last Verified: October 2026
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.
Surgery To Reshape The Face, Surgery To Reconstruct The Bones In The Center Of The Face. The Procedure Corrects Abnormalities Of The Head And Face.
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 21188 |
National average reimbursement for CPT 21188 by major payers:
$1,964.64
$2,176.28
$2,217.26
$2,631.47
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CPT 21188
5 of 25 sample ratesHigher to lower in this preview
Lubbock County Hospital District, University Medical Center
Lubbock County Hospital District
$10,546.00Published rateProliance Surgeons, Inc., P.S., Proliance Puget Sound Surgery Center
Proliance Surgeons, Inc., P.S.
$4,785.00Published rateSpeedway Surgical Specialists, LLC
Speedway Surgical Specialists LLC
$2,600.00Published rateComprehensive Pain Center For Surgery, Fountains Specialty Surgical Center
Comprehensive Pain Center For Surgery
$1,401.00Published rateArmenia Ambulatory Surgery Center LLC, Medical Village Surgical Center
$730.00Published rate
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See a sample payer proposalCPT 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 | Rcnstj Mdfc Lefort I 2 W/Grf, 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 | Lefort I 3 Piece W Graft, 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 | Surgery To Reshape The Face, Surgery To Reconstruct The Bones In The Center Of The Face. The Procedure Corrects Abnormalities Of The Head And Face. |
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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