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 |
| Medicare Fee Schedule | View Medicare rates for 21260 |
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 | $2900.00 | 1750905618 - RSPS FAYETTEVILLE ASC LLC, RSPS FAYETTEVILLE ASC | 851271440 - (GA) RSPS FAYETTEVILLE ASC LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $7391.00 | 1598729329 - SURGICARE OF ST ANDREWS LTD | 611276561 - (FL) SURGICARE OF ST ANDREWS LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $1400.00 | 1841039443 - PACIFIC GASTRO HEALTH PLLC, PACIFIC GASTRO HEALTH | 201377401 - (WA) PACIFIC GASTROENTEROLOGY, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $3914.00 | 1790130672 - PROSPECT DCMH, LLC, SHORT PROCEDURE UNIT | 811520273 | PA | 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 | $1035.00 | 1679612253 - WALKER SURGICAL CENTER LLC | 810635117 - (MI) WALKER SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $800.00 | 1407801509 - ATLANTIC SURGERY CENTER,LLC | 223625894 - (NJ) ATLANTIC SURGERY CENTERLLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $1584.00 | 1316375884 - OXON HILL UROLOGY SURGERY CENTER PC | 463746777 - (MD) OXON HILL UROLOGY SURGERY CENTER PC | MD | 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 | $5433.00 | 1366982845 - JACKSONVILLE ENDOSCOPY CENTERS LLC, JACKSONVILLE CENTER FOR ENDOSCOPY | 384016302 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5433.00 | 1205949245 - MEMORIAL SURGERY CENTER, LLC | 201167151 - (OK) MEMORIAL SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $2251.00 | 1104877976 - VICTOR R. MICHALAK, DBA COSMETIC SURGERY & DERMATOLOGY OF ISSAQUAH, INC. | 911521306 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5249.00 | 1730175159 - CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC, CHARLOTTE SURGERY CENTER | 651071112 - (FL) CHARLOTTE ENDOSCOPIC SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5020.00 | 1790252864 - TREASURE COAST ASC, LLC, TREASURE COAST CENTER FOR SURGERY | 384092821 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21260 | $5354.00 | 1275198673 - UROLOGY ASC- PHOENIX, LLC, UROLOGIC SURGERY CENTER OF ARIZONA | 320586987 | AZ | 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-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 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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