CPT 21194 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 • 59 - Distinct Procedural Service • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21194 |
National average reimbursement for CPT 21194 by major payers:
$1,740.19
$1,915.56
$1,973.47
$2,392.47
| 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 21194 | ||||||
United | 21194 | $2674.00 | 1811262363 - PRECISION SURGERY CENTER, LLC | 453655088 - (KS) PRECISION SURGERY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $7391.00 | 1215307012 - BAY AREA SURGICENTER, LLC, BRANDON SURGERY CENTER | 474961128 - (FL) BAY AREA SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $2801.00 | 1801952783 - AMBULATORY SURGICENTER OF DOWNERS GROVE | 364106726 - (IL) AMBULATORY SURGICENTER OF DOWNERS GROVE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $2736.00 | 1750169975 - UNOVA ASC, INC | 812495096 - (FL) UNOVA ASC INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $3320.00 | 1073758298 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT GALLOWAY NORTH | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $1374.00 | 1205963568 - BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | 231714249 - (PA) BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $5433.00 | 1568674281 - VILLAGES ENDOSCOPY & SURGICAL CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $1830.00 | 1679556864 - DOCTORS GI PARTNERSHIP LTD, HF SURGERY CENTER AT BABCOCK | 593758988 - (FL) DOCTORS GI PARTNERSHIP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $3365.00 | 1821249616 - LINCOLN SURGERY CENTER LLC | 261790900 - (CO) LINCOLN SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $2565.00 | 1902850571 - SDM ASC LLC, DAYTIME OUTPATIENT SURGERY CENTER | 752816595 - (TX) SDM ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $3339.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 431704371 - FREEMAN HEALTH SYSTEM | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $4703.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $6912.00 | 1164056974 - ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY LLC | 842016212 - (WI) ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $1665.00 | 1790744175 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, PUYALLUP ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21194 | $876.00 | 1104857523 - SURGERY CENTER OF ST. JOSEPH, LLC | 371439847 - (MO) SURGERY CENTER OF ST JOSEPH LLC | MO | 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 21194 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21194 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 21194 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 21194. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21194 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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