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See a sample rate comparisonCPT 21256 Fee Schedule
Last Verified: October 2026
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.
Reconstruction Of Orbit With O, Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Grafts (Includes Obtaining Autografts) (Eg Microophthalmia)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 50 - Bilateral Procedure 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21256 |
| Medicaid Fee Schedule | View Medicaid rates for 21256 |
National average reimbursement for CPT 21256 by major payers:
$1,597.81
$1,642.51
$1,705.40
$2,009.67
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CPT 21256
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC, Aurora Pleasant Prairie Ambulatory Surgery Center
Aurora Surgery Centers LLC
$10,989.00Published rateRiverside Park Surgicenter LLC
$5,354.00Published ratePardee Ambulatory Surgery Center LLC, The Surgery Center At Mills River
Pardee Ambulatory Surgery Center LLC
$2,888.00Published rateSurgical Park Center Ltd
$2,014.00Published rateBayside Endoscopy Center LLC, East Greenwich Endoscopy Center
Bayside Endoscopy Center LLC
$1,225.00Published rate
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See a sample payer proposalCPT 21256 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21256 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 21256 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 |
|---|---|---|
| 21255-CPT | High | Reconstruction With Bone Graft, Surgery To Reconstruct The Face Just Below The Cheekbone Using Bone And Cartilage From The Hip Rib Or Skull. |
| 21256-CPT | High | Reconstruction Of Orbit With O, Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Grafts (Includes Obtaining Autografts) (Eg Microophthalmia) |
| 21260-CPT | High | Periorbital Osteotomies For Orbital Hypertelorism W/ Bone Grafts, Periorbital Osteotomies For Orbital Hypertelorism With Bone Grafts; E |
| 21261-CPT | High | Periorbital Osteotomies For Or, Periorbital Osteotomies For Orbital Hypertelorismwith Bonegrafts Combined Intra- And Extracranial Approach |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21256. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21256 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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