CPT 21198 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 • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21198 |
National average reimbursement for CPT 21198 by major payers:
$1,352.21
$1,505.20
$1,555.05
$1,797.50
| 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 21198 | ||||||
United | 21198 | $949.00 | 1639176183 - BERKS CENTER FOR DIGESTIVE HEALTH, LP | 233068912 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $4041.00 | 1346403854 - THE EMORY CLINIC INC, EMORY ORTHOPAEDIC SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $2408.00 | 1457891426 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE CENTER FOR OUTPATIENT SPINE AND JOINT SURGERY | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1968.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1100.00 | 1881131621 - FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC, AZURA SURGERY CENTER RENALUS PENSACOLA | 814605951 - (FL) FRESENIUS VASCULAR CARE OF PENSACOLA ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $760.00 | 1396069902 - SOUTHERN IDAHO SURGERY CENTER PLLC | 451149795 - (ID) SOUTHERN IDAHO SURGERY CENTER PLLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1475.00 | 1366864514 - GREAT SOUTH BAY ENDOSCOPY CENTER, LLC | 463055867 - (NY) GREAT SOUTH BAY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $2353.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $2990.00 | 1831576891 - ADVANCED SURGERY CENTER PERIMETER, LLC | 473080613 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1391.00 | 1437101433 - TRI CITY SURGERY CENTER LLC | 201504745 - (AZ) TRI-CITY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1530.00 | 1114057023 - CROSSROADS SURGERY CENTER INC | 205799348 - (MN) CROSSROADS SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $900.00 | 1669621496 - CPM SURGERY CENTER 3, LLC | 263297851 - (GA) CPM SURGERY CENTER 3 LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1377.00 | 1497314181 - OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC | 832118109 - (IL) OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $2300.00 | 1205171295 - VANCE THOMPSON VISION SURGERY CENTER PROF LLC, VANCE THOMPSON VISION SURGERY CENTER | 843362063 | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21198 | $1962.00 | 1073763652 - LEBONHEUR EAST SURGERY CENTER II LP, LEBONHEUR EAST SURGERY CENTER LP | 800247391 - (TN) LEBONHEUR EAST SURGERY CENTER II LP | TN | 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 21198 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21198 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 21198 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 |
| 21198-CPT | High | Osteotomy Mandible Segmental |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21198. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21198 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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