CPT 21256 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 50 - Bilateral Procedure • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 21256 by major payers:
$1,597.81
$1,642.51
$1,705.40
$2,053.95
| 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 21256 | ||||||
United | 21256 | $2912.00 | 1558926931 - WELLNESS AMBULATORY SURGERY CENTER, LLC | 810848308 - (TX) WELLNESS AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2400.00 | 1699959387 - SAN DIEGO CA MULTI SPECIALTY ASC LLC, MISSION VALLEY HEIGHTS SURGERY CENTER | 261158246 - (CA) POWAY CA MULTI-SPECIALTY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2281.00 | 1982641890 - SUMMIT MEDICAL GROUP PA, SUMMIT MEDICAL GROUP AMBULATORY SURGERY CENTER | 223487984 - SUMMIT MEDICAL GROUP, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2755.00 | 1780735175 - THE CENTER FOR SPINE PROCEDURES, LLC | 421587967 - (GA) THE CENTER FOR SPINE PROCEDURES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2800.00 | 1740700111 - M. REZA MIZANI, M.D., P.A., TOTAL VASCULAR CARE | 200743330 - (TX) M. REZA MIZANI MD, PA | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $5966.00 | 1558487009 - MIDWEST DIGESTIVE HEALTH CENTER LLC | 431918703 - (MO) MIDWEST DIGESTIVE HEALTH CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1248.00 | 1902849227 - EYE SURGERY CENTER, LLC | 371221499 - (IL) EYECARE MANAGEMENT, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2689.00 | 1386858595 - ALDERWOOD SURGERY CENTER LLC | 204979154 - (WA) ALDERWOOD SURGICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1700.00 | 1306214705 - GSI ASC, LLC | 474883816 - (OK) GSI ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1300.00 | 1609803204 - AFFILIATED ENDOSCOPY SERVICES OF CLIFTON LLC, AFFILIATED ENDOSCOPY SERVICES OF CLIFTON | 270064844 - (NJ) AFFILIATED ENDOSCOPY SERVICES OF CLIFTON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $3438.00 | 1811148869 - ENDOSCOPY CENTER OF THE ROCKIES LLC | 841562782 - (CO) ENDOSCOPY CENTER OF THE ROCKIES LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1039.00 | 1801811773 - DUPAGE EYE SURGERY CENTER, LLC | 920189811 - (IL) DUPAGE EYE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $5249.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $8238.00 | 1881620995 - MCKINNEY SURGERY CENTER, LP, THE SURGERY CENTRE AT CRAIG RANCH | 383897811 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $5020.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | 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 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 | High | Recon Zygomatic Arch/Glenoid Fossa W/Aut |
| 21256 | High | Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Grafts (Includes Obtaining Autografts) (Eg, Micro-Ophthalmia) |
| 21260 | High | Periorbital Osteotomy W/Graft Extracrani |
| 21261 | High | Rep Orbit Hypertelorism Combin Appr |
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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