CPT 21267 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 |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21267 |
National average reimbursement for CPT 21267 by major payers:
$1,903.93
$2,150.44
$2,188.97
$2,671.05
| 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 21267 | ||||||
United | 21267 | $874.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $1283.00 | 1487059002 - RIVERWALK ASC, LLC, RIVERWALK ASC | 472075991 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $3271.00 | 1508835299 - ALASKA DIGESTIVE CENTER, LLC | 481281732 - (AK) ALASKA DIGESTIVE CENTER LLC | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $1350.00 | 1730124561 - SURGERY CENTER OF WESTON LLC | 650933685 - (FL) SURGERY CENTER OF WESTON LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $2850.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $2108.00 | 1730252487 - J C PITTS ENTERPRISES INC, ONTARIO SURGERY CENTER | 930983555 - (OR) J C PITTS ENTERPRISES INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $2978.00 | 1871939082 - RAYMOND RENAISSANCE SURGERY CENTER LLC | 462035014 - (CA) RAYMOND RENAISSANCE SURGERY CE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $586.00 | 1306885256 - EYE SURGICAL CENTER, LLC, THE INSTITUTE FOR REFRACTIVE AND INTRAOCULAR SURGERY | 200318724 - (OH) EYE SURGICAL CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $4210.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $863.00 | 1295131001 - OPTUMCARE COLORADO ASC, LLC, COLORADO SPRINGS HEALTH PARTNERS ASC, LLC | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $894.00 | 1437237393 - LAUREL AMBULATORY SURGICAL CENTER | 263869837 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $2718.00 | 1881147965 - ULNA SURGERY CENTER LLC | 813050347 - (GA) ULNA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $3400.00 | 1649871450 - ADVANCED HEART AND VEIN SURGERY CENTER, LLC | 844546684 - (CO) ADVANCED HEART AND VEIN SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $1361.00 | 1215307012 - BAY AREA SURGICENTER, LLC, BRANDON SURGERY CENTER | 474961128 - (FL) BAY AREA SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21267 | $1790.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | 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 21267 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21267 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 21267 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 |
| 21267-CPT | High | Reposition Orbit Unil Extracranial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21267. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21267 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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