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See a sample rate comparisonCPT 21263 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.
Periorbital Osteotomies For Orbital Hypertelorism W/ Bone Grafts, Periorbital Osteotomies For Orbital Hypertelorism With Bone Grafts; W
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | None 62 - Co-Surgeons 22 - Increased Procedural Services GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21263 |
| Medicaid Fee Schedule | View Medicaid rates for 21263 |
National average reimbursement for CPT 21263 by major payers:
$2,784.46
$2,864.58
$2,943.46
$3,609.21
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CPT 21263
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Wasilla, LLC
Surgery Center Of Wasilla LLC
$19,404.00Published rateTlc Asc, LLC, Kzmss Again, Lllp
Tlc Asc LLC
$5,433.00Published rateSummit Ambulatory Surgical Center, LLC
$2,682.00Published rateSpecialty Surgicare Of Las Vegas, Lp
$1,471.00Published rateInterventional Rehabilitation Center, LLC
Interventional Rehabilitation Center LLC
$626.00Published rate
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See a sample payer proposalCPT 21263 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21263 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 21263 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 |
| 21263-CPT | High | Periorbital Osteotomies For Orbital Hypertelorism W/ Bone Grafts, Periorbital Osteotomies For Orbital Hypertelorism With Bone Grafts; W |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21263 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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