CPT 21240 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 • 11 - Office |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21240 |
National average reimbursement for CPT 21240 by major payers:
$1,442.81
$1,466.93
$1,546.66
$1,805.21
| 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 21240 | ||||||
United | 21240 | $1230.00 | 1023256187 - TAMPA SURGERY CENTER LLC | 264008716 - (FL) TAMPA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $4810.00 | 1356490817 - CHRISTUS CABRINI SURGERY CENTER, LLC, CHRISTUS CABRINI SURGERY CENTER | 204705651 - CHRISTUS CABRINI SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $2400.00 | 1609223056 - HEART HEALTH CENTER, LLC | 473280746 - (AZ) HEART HEALTH CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $9106.00 | 1538179551 - HENRY FORD MEDICAL CENTER FAIRLANE, HENRY FORD HEALTH SYSTEM | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $5354.00 | 1356396857 - HOLSTON VALLEY AMBULATORY SURGERY CENTER, LLC | 621816864 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $2619.00 | 1992752794 - SIERRA EYE AMBULATORY SURGERY CENTER, LLC | 770509889 - (CA) SIERRA EYE AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $890.00 | 1821106923 - ENDOSCOPY CENTER OF COASTAL GEORGIA, LLC | 582628189 - (GA) ENDOSCOPY CENTER OF COASTAL GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $1350.00 | 1780767673 - EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC | 30527649 | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $3151.00 | 1023160553 - ALBANY SURGERY CENTER, LLP | 582437516 - (GA) ALBANY SURGERY CENTER LLP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $2149.00 | 1780218115 - SURGERY CENTER OF FORT WAYNE | 825163478 - (IN) SURGERY CENTER OF FORT WAYNE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $2400.00 | 1184922353 - PEARLAND SURGERY CENTER, LLC | 270289493 - (TX) PEARLAND SURGERY CENTER, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $7666.00 | 1447212121 - CHRISTUS SANTA ROSA OUTPATIENT SURGERY, CHRISTUS PHYSICIANS SURGERY CENTER - NEW BRAUNFELS | 810571409 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $5249.00 | 1538390539 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $1889.00 | 1871644823 - PERLOW FACILITY, LLC | 251926011 - (GA) PERLOW FACILITY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21240 | $2400.00 | 1154996361 - CHADDS FORD AMBULATORY SURGICAL CENTER, LLC | 831876495 - (PA) CHADDS FORD AMBULATORY SURGICAL CENTER 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 21240 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21240 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 21240 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 |
|---|---|---|
| 21240-CPT | High | Arthroplasty Temporomandib Unil |
| 21242-CPT | High | Arthroplasty Tmj Alloplastic Agent |
| 21243-CPT | High | Arthroplasty Tmj W/Pros Jnt Replace |
| 21244-CPT | High | Reconstruction Of Mandible, Extraoral, With Transosteal Bone Plate -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 21240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21240 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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