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 |
| Medicare Fee Schedule | View Medicare rates for 21256 |
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 | $2420.00 | 1356314249 - COLUMBIA ASC LLC, COLUMBIA GASTROINTESTINAL ENDOSCOPY CENTER | 621657449 - (SC) THE COLUMBIA ASC, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $10989.00 | 1497393516 - AURORA SURGERY CENTERS, LLC, AURORA PLEASANT PRAIRIE AMBULATORY SURGERY CENTER | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1300.00 | 1093723900 - CARTER REAL ESTATE PROPERTIES INC, NORTH DALLAS SURGICARE | 752521630 - (TX) CARTER REAL ESTATE PROPERTIES INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1286.00 | 1326084740 - ENDOSCOPY CENTER OF SW VA | 900165230 - (VA) ENDOSCOPY CENTER OF SW VA | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2390.00 | 1083144653 - GREATER PITTSBURGH SURGERY LLC | 821512721 - (PA) GREATER PITTSBURGH SURGERY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $5354.00 | 1881697522 - RIVERSIDE PARK SURGICENTER LLC | 593106055 - (FL) RIVERSIDE PARK SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $5354.00 | 1083176309 - SPICEWOOD SURGERY CENTER LLC, SPICEWOOD SURGERY CENTER | 834343089 - (TX) SPICEWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $2888.00 | 1922729847 - PARDEE AMBULATORY SURGERY CENTER LLC, THE SURGERY CENTER AT MILLS RIVER | 853190133 - (NC) PARDEE AMBULATORY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $7172.00 | 1316487093 - NORTH SHORE SURGICAL SUITES, LLC, NORTH SHORE SURGICAL SUITES | 814641285 - (WI) NORTH SHORE SURGICAL SUITES, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1375.00 | 1720080823 - BAPTIST-EMSC LP, EAST MEMPHIS SURGERY CENTER | 621846584 - (TN) BAPTISTEMSC LP | TN | 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 | $7391.00 | 1518920040 - COUNTRYSIDE SURGERY CENTER, LTD | 752400186 - (FL) COUNTRYSIDE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $3927.00 | 1710315619 - RIDGELINE SURGICENTER, LLC | 463848829 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21256 | $1910.00 | 1457826125 - CENTRAL OREGON SURGICAL INSTITUTE, LLC | 830651822 - (OR) CENTRAL OREGON SURGICAL INSTITUTE LLC | OR | 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 | 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-CPT | High | Recon Zygomatic Arch/Glenoid Fossa W/Aut |
| 21256-CPT | High | Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Grafts (Includes Obtaining Autografts) (Eg, Micro-Ophthalmia) |
| 21260-CPT | High | Periorbital Osteotomy W/Graft Extracrani |
| 21261-CPT | 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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