CPT 21280 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21280 |
National average reimbursement for CPT 21280 by major payers:
$749.53
$750.00
$797.80
$969.58
| 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 21280 | ||||||
United | 21280 | $1648.00 | 1639375108 - HEALING ARTS SURGERY CENTER INC | 204635621 - (CA) HEALING ARTS SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $1737.00 | 1902876212 - SCAC LLC, SURGERY CENTER AT CRANBERRY | 562286973 - (PA) SCAC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $8076.00 | 1750892659 - NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | 821651821 - (NC) NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2500.00 | 1902436348 - DLV VISION ASC | 842407060 - (CA) DLV VISION ASC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $1789.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2622.00 | 1881692036 - SAINT BARNABAS OUTPATIENT CENTERS, AMBULATORY SURGERY CENTER | 222458479 - (NJ) SAINT BARNABAS OUTPATIENT CENTERS | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2652.00 | 1144380163 - THE CENTRE LLC | 352121237 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2100.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $5249.00 | 1477700516 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $5354.00 | 1265466288 - TAMARAC SURGERY CENTER LLC, THE SURGERY CENTER OF FT LAUDERDALE | 650963549 - (FL) TAMARAC SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $8238.00 | 1841295425 - CROSS TIMBERS SURGERY CENTER, LLC, NORTH TEXAS GI CENTER | 752862780 - (TX) CROSS TIMBERS SURGERY CENTER, LP DBA NORTH TEXAS GI CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2240.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2817.00 | 1679544290 - KEYSTONE SURGERY CENTER, LTD | 43712391 - (PA) KEYSTONE SURGERY CENTER LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $2300.00 | 1811095136 - GROSSMONT OUTPATIENT SURGICAL CENTER | 953337109 - (CA) GROSSMONT OUTPATIENT SURGICAL CE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21280 | $752.00 | 1376748228 - FLORIDA SPECIALTY SURGERY CENTER LLC | 203672687 - (FL) FLORIDA SPECIALTY SURGERY CENTER 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 21280 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21280 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 21280 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 |
| 21280-CPT | Moderate | Reattachment Of Nasal And Eye Socket Ligament, Ear Side |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21280 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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