CPT 21260 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 78 - Return to OR - related procedure • 26 - Professional component • 80 - Assistant surgeon |
| Complexity Level | High |
National average reimbursement for CPT 21260 by major payers:
$1,638.43
$1,791.15
$1,838.96
$2,244.51
| 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 21260 | ||||||
United | 21260 | $2109.00 | 1972208379 - HIGH RESORT EYE SURGERY CENTER LLC | 923159505 - (NM) HIGH RESORT EYE SURGERY CENTER LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $1311.00 | 1144482753 - CLARKSVILLE EYE SURGERY CENTER | 261815638 - (TN) CLARKSVILLE EYE SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $4406.00 | 1316939556 - SEQUOIA SURGICAL CENTER LP, SEQUOIA SURGICAL PAVILION | 364408212 - (CA) SEQUOIA SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $6506.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5249.00 | 1043605934 - SEASIDE SURGERY CENTER, LLC | 472399984 - (FL) SEASIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $2375.00 | 1215204128 - MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, P.C., ALLSPINE SURGERY CENTER, P.C. | 274395849 - (GA) MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $1603.00 | 1366484776 - DUTCHESS SURGICAL CENTER | 141803011 - (NY) DUTCHESS AMBULATORY SURGICAL CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $3452.00 | 1295288751 - PLASTIC HEAD AND NECK SURGERY INSTITUTE | 812018399 - (GA) PLASTIC HEAD AND NECK SURGERY INSTITUTE | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5433.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $3400.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 455323939 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $2520.00 | 1760196984 - JACKSON HEART AND VASCULAR CENTER LLC | 870947298 - (MS) JACKSON HEART AND VASCULAR CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $4839.00 | 1932164852 - MAY STREET SURGI CENTER, LLC, MAY STREET SURGI CENTER | 223777533 - (NJ) MAY STREET SURGI CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $1328.02 | 1013984657 - MAYFAIR DIGESTIVE HEALTH CENTER, LLC | 50525982 - (WI) MAYFAIR DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $150.00 | 1790172922 - YUMA VALLEY AMBULATORY PAIN SERVICES INC | 471779727 - (AZ) YUMA VALLEY AMBULATORY PAIN SERVICES INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $3834.00 | 1326557653 - SJ EAST CAMPUS ASC, LLC, DENVER SURGERY CENTER | 821485491 - (CO) SJ EAST CAMPUS ASC LLC | CO | 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 21260 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21260 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 21260 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 21260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21260 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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