CPT 21268 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 | • 11 - Office • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • SC - Medically necessary service or supply • 80 - Assistant surgeon • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21268 |
National average reimbursement for CPT 21268 by major payers:
$2,499.91
$2,618.71
$2,668.36
$3,279.09
| 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 21268 | ||||||
United | 21268 | $390.00 | 1982696894 - AFFILIATED AMBULATORY SURGERY CENTER LLC | 311719268 - (OH) AFFILIATED AMBULATORY SURGERY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $3219.00 | 1144827114 - GULFSTREAM SURGICAL FORT WORTH LLC | 851495125 - (TX) GULFSTREAM SURGICAL FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $6050.00 | 1487933172 - MT. SCOTT SURGERY CENTER, LLC | 832600045 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $2392.00 | 1912158684 - SURGCENTER OF BEL AIR | 262215322 - (MD) SURGCENTER OF BEL AIR, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $3532.00 | 1235155730 - MONTPELIER SURGERY CENTER | 770548811 - (CA) MONTPELIER SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $2383.00 | 1922052364 - AMARILLO SURGERY AND ENDOSCOPY, LP, ADC ENDOSCOPY SPECIALISTS | 203590535 - (TX) AMARILLO SURGERY AND ENDOSCOPY LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $519.00 | 1063584415 - CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA, CAROLINA DIGESTIVE ENDOSCOPY CENTER | 561335864 - (NC) CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $750.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $1700.00 | 1457813107 - SURGEON'S SURGERY CENTER SORELLE PLLC | 831414422 - (NV) SURGEONS SURGERY CENTER SORELLE PLLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $2000.00 | 1275077414 - SKI AMBULATORY SURGICAL CENTERS, LLC | 813831008 - (AZ) SKI AMBULATORY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $5002.00 | 1659316917 - SUGAR LAND SURGERY CENTER LTD | 621742196 - (TX) SUGAR LAND SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $1350.00 | 1043564784 - COMPREHENSIVE SURGICAL CENTER OF GREEN, LLC | 461313857 - (OH) COMPREHENSIVE SURGICAL CENTER OF GREEN LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $3950.00 | 1417278011 - WILSHIRE SURGERY CENTER, LLC | 270616665 - (OR) WILSHIRE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $4704.00 | 1962681130 - BAYLOR SURGICARE AT PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE - PLANO | 260308454 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21268 | $3363.00 | 1982360780 - SMARTCARE PALM HARBOR, LLC | 853980592 - (FL) SMARTCARE PALM HARBOR LLC | FL | 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 21268 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21268 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 21268 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 |
| 21268-CPT | High | Orbit Reposition Unilat W/Graft Intra/Ex |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21268. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21268 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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