CPT 21247 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 UB 50 - Bilateral Procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21247 |
| Medicaid Fee Schedule | View Medicaid rates for 21247 |
National average reimbursement for CPT 21247 by major payers:
$2,131.98
$2,164.22
$2,163.64
$2,625.40
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 21247 | $1737.00 | 1922180439 - DL-JT MANAGEMENT SERVICES, LLC, CENTENNIAL SURGERY CENTER, LLC | 880499721 - CENTENNIAL SPINE & PAIN CENTER | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $3895.00 | 1396784252 - FRONTENAC AMBULATORY SURGERY & SPINE CARE CENTER LP, FRONTENAC SURGERY & SPINE CARE CENTER | 205953268 - (MO) FRONTENAC AMBULATORY SURGERY SPINE CARE CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $2004.00 | 1235241688 - SAN ANTONIO ASC L.P., SPECIALTY SURGERY CENTER | 742863505 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $3690.00 | 1689639692 - SURGICAL CENTER OF SOUTH JERSEY LIMITED PARTNERSHIP | 222709324 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $1667.00 | 1306924170 - DELMAR SURGICAL CENTER LLC | 621717312 - (MD) DELMAR SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $3800.00 | 1245207687 - CDI TWIN CITIES ASC LLC, RAYUS TWIN CITIES ASC | 820565885 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $2919.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $5249.00 | 1992713176 - DESERT RIDGE OUTPATIENT SURGERY LLC | 202528902 - (AZ) DESERT RIDGE OUTPATIENT SURGERY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $16929.00 | 1215060546 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $1326.00 | 1598744732 - MIDWEST EYE SURGERY CENTER, LLC | 470831193 - (NE) MIDWEST EYE SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $5354.00 | 1063099190 - ASCENSION SAINT THOMAS LEBANON SURGERY CENTER LLC, LEBANON SURGERY CENTER | 862679471 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $1693.00 | 1356421853 - PINEHURST MEDICAL CLINIC INC, PINEHURST MEDICAL CLINIC ENDOSCOPY CENTER | 560942980 - (NC) PINEHURST MEDICAL CLINIC, INC. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $3452.00 | 1295288751 - PLASTIC HEAD AND NECK SURGERY INSTITUTE | 812018399 - (GA) PLASTIC HEAD AND NECK SURGERY INSTITUTE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $2543.00 | 1689633588 - SOUTH JERSEY ENDOSCOPY LLC, DIMARINO-KROOP-PRIETO GI ASSOC | 200478348 - (NJ) SOUTH JERSEY ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21247 | $5020.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | 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 21247 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21247 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 21247 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 |
|---|---|---|
| 21244-CPT | High | Reconstruct Jaw And Teeth, Surgery To Reconstruct The Jaw Using An Artificial Part With Posts That Extend Through The Upper Or Lower Jaw Into The Mouth. Dentures Are Attached To The Posts To Replace Missing Teeth. |
| 21245-CPT | High | Reconstruct Jaw And Teeth, Surgery To Reconstruct The Jaw Using An Artificial Part With Posts That Extend Through The Upper Or Lower Jaw Into The Mouth. Dentures Are Attached To The Posts To Replace Missing Teeth. |
| 21246-CPT | High | Reconstruct Jaw And Teeth, Surgery To Reconstruct The Jaw Using An Artificial Part With Posts That Extend Through The Upper Or Lower Jaw Into The Mouth. Dentures Are Attached To The Posts To Replace Missing Teeth. |
| 21247-CPT | High | Reconstruction Of Mandibular C, Reconstruction Of Mandibular Condyle With Bone Andcartilageautografts (Includes Obtaining Grafts) ( Eg For Hemifacial Microsomia) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21247. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21247 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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