CPT 21199 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 • 80 - Assistant surgeon • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21199 |
National average reimbursement for CPT 21199 by major payers:
$1,295.28
$1,392.15
$1,442.83
$1,719.58
| 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 21199 | ||||||
United | 21199 | $4558.00 | 1588785208 - AMBER MEADOWS SURGERY CENTER LLC | 208756114 - (MD) AMBER MEADOWS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $3882.00 | 1922526961 - BLAINE ASC, LLC, BLAINE ORTHOPEDIC SURGERY CENTER | 822416401 - (MN) BLAINE ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $1988.00 | 1013980317 - LOS ANGELES-INGLEWOOD ENDOSCOPY LP, AIRPORT ENDOSCOPY CENTER | 621814135 - (CA) LOS ANGELESINGLEWOOD ENDOSCOPY LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $3003.00 | 1770598591 - BOISE CENTER FOR FOOT SURGERY PLLC, MILLENNIUM SURGERY CENTER | 820477586 - (ID) BOISE CENTER FOR FOOT SURGERY PLLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $2245.00 | 1033105960 - SURGERY CENTER OF OAK RIDGE, LLC, ADVANCED FAMILY SURGERY CENTER | 621801416 - (TN) ADVANCED FAMILY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $1233.00 | 1225039761 - ENDOSCOPY CENTER OF ST THOMAS LLC, ST THOMAS MEDICAL GROUP ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $2733.00 | 1033399084 - HIGH DESERT SURGERY CENTER, L.L.C. | 261367869 - (WA) HIGH DESERT SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $2444.00 | 1467844068 - WEST ANNAPOLIS SURGERY CENTER, LLC | 472474153 - (MD) WEST ANNAPOLIS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $9251.00 | 1811101439 - SENTARA OBICI AMBULATORY SURGERY, LLC | 260144898 - (VA) SENTARA OBICI AMBULATORY SURGERY, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $4704.00 | 1275536328 - BELLAIRE OUTPATIENT SURGERY CENTER, LLP, BAYLOR SCOTT & WHITE SURGICARE - OAKMONT | 562297308 - (TX) BELLAIRE OUTPATIENT SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $2280.00 | 1548374267 - DALLAS SURGI CENTER, INC. | 752199927 - (TX) DALLAS SURGI CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $4625.00 | 1629703236 - NORTH CYPRESS SURGICENTER, LLC, NORTH CYPRESS SURGERY CENTER | 851383722 - (TX) NORTH CYPRESS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $1838.00 | 1962459610 - CENTRAL TEXAS DAY SURGERY CENTER LIMITED PARTNERSHIP | 752477808 - (TX) CENTRAL TEXAS DAY SURGERY CENTER LIMITED PARTNERSHIP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $1669.00 | 1154986347 - CENTER FOR VISUAL SURGICAL EXCELLENCE, LLC | 820674025 - (VA) CENTER FOR VISUAL SURGICAL EXCELLENCE LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21199 | $1273.00 | 1548223654 - SPARTAN HEALTH SURGICENTER LLC | 251898641 - (PA) SPARTAN HEALTH SURGICENTER, LLC | PA | 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 21199 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21199 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 21199 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 |
| 21199-CPT | High | Osteotomy, Mandible, Segmental; With Genioglossus Advancement -Commercial Rn Review>=1/1/2001: Medicaid Rn Review=1/1/2001-9/30/2020 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21199 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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