CPT 21248 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21248 |
National average reimbursement for CPT 21248 by major payers:
$1,199.01
$1,388.24
$1,382.49
$1,709.37
| 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 21248 | ||||||
United | 21248 | $5020.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $3398.00 | 1851865828 - ATLANTA SURGERY NORTH | 832134639 - (GA) ATLANTA SURGERY NORTH | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2512.00 | 1699711556 - ESCNC LLC, EYE SURGERY CENTER OF NORTHERN CALIFORNIA | 462800751 - (CA) ESCNC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2890.00 | 1235240813 - NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | 200145190 - (MS) NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2927.00 | 1184106049 - SURGCENTER OF NORTHERN BALTIMORE, LLC | 823078615 - (MD) SURGCENTER OF NORTHERN BALTIMORE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $5240.00 | 1114264488 - EXECUTIVE SURGERY CENTER, LLC | 300701899 - (TX) EXECUTIVE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $1500.00 | 1356729636 - R CHOICE SURGICAL CENTER LLC | 473918510 - (NE) R CHOICE SURGICAL CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $1968.00 | 1295948339 - WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER, INC | 463956703 - (NC) WILMINGTON GASTROENTEROLOGY ENDOSCOPY CENTER INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2358.00 | 1881250652 - TEREDESAI MCCANN & ASSOCIATES PC, TMA VASCULAR ACCESS CENTER | 251403041 - (PA) TEREDESAI MCCANN & ASSOCIATES, P.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2250.00 | 1306043617 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $6506.00 | 1902959190 - RIVA ROAD SURGICAL CENTER, LLC | 870774597 - (MD) RIVA ROAD SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $6452.00 | 1255353389 - SOMERSET AMBULATORY SURGICAL CENTER, LLC | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $1567.00 | 1902875438 - CENTRAL PARK ENDOSCOPY CENTER LLC, ENDOSCOPY CENTER AT CENTRAL PARK | 752894418 - (TX) CENTRAL PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2100.00 | 1689188823 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21248 | $2480.00 | 1598227431 - SURGERY CENTER OF CONWAY INC | 821792579 - (SC) SURGERY CENTER OF CONWAY, INC. | SC | 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 21248 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21248 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 21248 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 | Reconstruction Of Mandible, Extraoral, With Transosteal Bone Plate -Commercial Rn Review>=1/1/1996: Medicaid Rn Review=1/1/1996-9/30/2020 |
| 21245-CPT | High | Recon Mand Max Subperiosteal Part |
| 21246-CPT | High | Repair Jaw W Subperiost Implnt Tot |
| 21248-CPT | High | Recon Mandible Maxilla Endosteal Implant |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21248. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21248 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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