CPT 21315 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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • 54 - Surgical Care Only • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21315 |
National average reimbursement for CPT 21315 by major payers:
$235.67
$343.59
$305.68
$327.70
| 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 21315 | ||||||
United | 21315 | $785.00 | 1235683798 - ASSOCIATED SURGICAL CENTER LLC | 813492018 - (IL) ASSOCIATED SURGICAL CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $450.00 | 1972770022 - OUTPATIENT EYE SURGERY CENTER | 721098835 - (LA) OUTPATIENT EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $1955.00 | 1124083076 - NORTH GARLAND SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - NORTH GARLAND | 562399993 - (TX) NORTH GARLAND SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $1281.00 | 1023036688 - BAYSIDE AMBULATORY CENTER, LLC | 510438152 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $1166.00 | 1861041139 - KADLEC REGIONAL MEDICAL CENTER, KADLEC AMBULATORY ENDOSCOPY CENTER, LEE CAMPUS | 910655392 - KADLEC REGIONAL MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $845.00 | 1720011042 - PREMIER ORTHOPAEDIC SURGERY CENTER, LLC | 352433859 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $788.00 | 1609375682 - LUTHERVILLE SURGERY CENTER, LLC | 823355711 - (MD) LUTHERVILLE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $780.00 | 1407327356 - ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC, SURGERY CENTER OF BEVERLY HILLS LLC | 832822673 - (CA) ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $640.00 | 1396719563 - BAPTIST GERMANTOWN SURGERY CENTER, LLC, BAPTIST GERMANTOWN SURGERY CENTER | 621829424 - (TN) BAPTIST GERMANTOWN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $725.00 | 1598412256 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $1276.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $629.00 | 1902863723 - OAK & MAIN SURGICENTER LLC | 223532371 - (NJ) OAK MAIN SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $2622.00 | 1568979805 - ST DAVIDS AUSTIN AREA ASC LLC, ST . DAVID'S AUSTIN SURGERY CENTER | 611760247 - (TX) ST DAVIDS AUSTIN AREA ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $1666.00 | 1194770974 - HAMILTON ENDOSCOPY AND SURGERY CENTER, LLC | 223837967 - (NJ) HAMILTON ENDOSCOPY & SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21315 | $536.00 | 1740529064 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | 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 21315 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21315 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 21315 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 |
|---|---|---|
| 21282-CPT | Moderate | Reattachment Of Nasal And Eye Socket Ligament, Nose Side |
| 21315-CPT | Moderate | Closed Treatment Of Nasal Bone Fracture With Mani-Pulation; Without Stabilization (Desc Rvsd 1/1/22) |
| 21320-CPT | Moderate | Closed Treatment Of Nasal Bone Fracture; With With Manipulation; With Stabilization (Desc Rvsd 1/1/22) |
| 21330-CPT | Moderate | Red Fx Open-Nasal Complic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21315 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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