CPT 21193 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21193 |
National average reimbursement for CPT 21193 by major payers:
$1,555.88
$1,675.51
$1,724.73
$2,081.91
| 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 21193 | ||||||
United | 21193 | $3300.00 | 1952776098 - BAYTOWN ASC, LP, BAYTOWN HEART & VASCULAR SURGERY CENTER | 474501044 - (TX) BAYTOWN ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $8054.00 | 1225064736 - NMC SURGERY CENTER, L.P., THE SURGERY CENTER OF NACOGDOCHES | 752793512 - (TX) NMC SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $2718.00 | 1285912923 - ATLANTA HAND SPECIALIST SURGERY CENTER LLC | 452458463 - (GA) ATLANTA HAND SPECIALIST SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $3000.00 | 1619557519 - SCOTTSDALE MULTISPECIALTY SURGERY CENTER, PARADISE VALLEY MULTI SPECIALTY SURGERY CENTER | 833515797 - (AZ) SCOTTSDALE MULTISPECIALTY SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $3484.00 | 1245436823 - EASTERN MASSACHUSETTS SURGERY CENTER LLC, EASTERN MASSACHUSETTS SURGERY CENTER | 260393450 - (MA) EASTERN MASSACHUSETTS SURGERY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $713.00 | 1629133442 - ARIZONA SURGICAL ARTS, INC. | 860607769 - (AZ) ARIZONA SURGICAL ARTS INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $5020.00 | 1003813221 - UNIVERSITY SURGERY CENTER LTD | 742894406 - (FL) UNIVERSITY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $1500.00 | 1336324045 - MCCANDLESS ENDOSCOPY CENTER, LLC | 261284448 - (PA) MCCANDLESS ENDOSCOPY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $3956.00 | 1538736459 - PONY CREEK ANNEX, LLC | 844833158 - (OR) PONY CREEK ANNEX LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $5249.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $1898.00 | 1609871680 - LAUREL MD ENDOSCOPY ASC LLC, AMBULATORY ENDOSCOPY CENTER OF MARYLAND | 203959465 - (MD) LAUREL MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $6506.00 | 1205195716 - ADVANCED ENDOSCOPY AND PAIN CENTER LLC | 454651695 - (CA) ADVANCED ENDOSCOPY AND PAIN CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $5433.00 | 1154497964 - PANKRATZ EYE INSTITUTE, LLC, COLUMBUS EYE SUGERY CENTER, LLC, DBA PANKRATZ EYE INSTITUTE | 352092292 - (IN) PANKRATZ EYE INSTITUTE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $3050.00 | 1184699878 - NOC SURGERY CENTER LLC, LOC SURGERY CENTER | 470877119 - (NE) NOC SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21193 | $4000.00 | 1013104389 - TRACY SURGERY CENTER, LLC, TRACY SURGERY CENTER, LLC | 203762687 - (CA) TRACY 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 21193 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21193 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 21193 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 |
|---|---|---|
| 21193-CPT | High | Reconstruction Of Mandibular Rami, Horizontal, Vertical, C, Or L Osteotomy; Without Bone Graft -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21194-CPT | High | Reconstruction Of Mandibular Rami, Horizontal, Vertical, C, Or L Osteotomy; With Bone Graft -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21195-CPT | High | Reconstruction Of Mandibular Rami &/Or Body, Sagittal Split; Without Internal Rigid Fixation -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21196-CPT | High | Reconstruction Of Mandibular Rami &/Or Body, Sagittal Split; With Internal Rigid Fixation -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 21193. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21193 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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