CPT 21296 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 50 - Bilateral Procedure • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21296 |
National average reimbursement for CPT 21296 by major payers:
$555.08
$548.14
$595.93
$693.34
| 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 21296 | ||||||
United | 21296 | $872.00 | 1578525283 - PRINCETON ENDOSCOPY CENTER LLC | 200445094 - (NJ) PRINCETON ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $8705.00 | 1275881179 - EAGLE HIGHLANDS SURGERY CENTER, LLC, MERIDIAN SOUTH SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1517.00 | 1588631832 - SURGICAL SERVICES OF MICHIGAN, LLC, BLAKE WOODS MEDICAL PARK | 383234723 - (MI) BLAKE WOODS MEDICAL PARK | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1400.00 | 1821379538 - THE AESTHETIC SURGERY CENTRE, PLLC, CEDAR LASER AND SURGERY CENTER | 900210545 - (WA) AESTHETIC SURGERY CENTRE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1072.00 | 1023169380 - JCMG SURGERY CENTER, INC. | 431809950 - (MO) JCMG SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1600.00 | 1043660442 - GEORGIA INTERVENTIONAL PAIN | 812790376 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $2285.00 | 1083715148 - ASC SURGICAL VENTURES, LLC, OSMC OUTPATIENT SURGERY CENTER | 351995261 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $2388.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $966.00 | 1164473922 - OPHTHALMOLOGY CENTER OF BREVARD LP, ASC OF BREVARD | 621546274 - (FL) OPHTHALMOLOGY CENTER OF BREVARD LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $688.00 | 1023256187 - TAMPA SURGERY CENTER LLC | 264008716 - (FL) TAMPA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $520.00 | 1689682247 - ST. PETERSBURG ENDOSCOPY CENTER LLC | 203046109 - (FL) ST. PETERSBURG ENDOSCOPY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1151.00 | 1669474748 - ARC KENTUCKY LLC, DUPONT SURGERY CENTER | 621754364 - (KY) ARC KENTUCKY LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1475.00 | 1043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER | 911954101 - (WA) SKIN SURGERY CENTER P. S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $500.00 | 1326340852 - THE SURGICAL INSTITUTE OF MONROE AMBULATORY SURGERY CENTER LLC, SURGICAL INSTITUTE OF MONROE | 270843485 - (MI) SURGICAL INSTITUTE OF MONROE | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21296 | $1326.00 | 1851678981 - RIDGECREST SPECIALTY SURGERY CENTER, A PROFESSIONAL CORPORATION | 453602999 - (CA) RIDGECREST SPECIALTY SURGERY CENTER A PROFESSIONAL CORPORATION | CA | 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 21296 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21296 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 21296 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 |
|---|---|---|
| 21295-CPT | Moderate | Reduction Of Masseter Muscle And Bone (Eg, For Treatment Of Benign Masseteric Hypertrophy); Extraoral Approach |
| 21296-CPT | Moderate | Reduction Of Masseter Muscle And Bone (Eg, For Treatment Of Benign Masseteric Hypertrophy); Intraoral Approach |
| 21356-CPT | Moderate | Open Treat Depress Zygomatic Fract |
| 21365-CPT | High | Open Treatment Of Complicated (Eg, Comminuted Or Involving Cranial Nerve Foramina) Fracture(S) Of Malar Area, Including Zygomatic Arch And Malar Tripod; With Internal Fixation And Multiple Surgical Approaches |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21296 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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