CPT 21320 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 • SG - Scene to Hospital ESRD facility • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21320 |
National average reimbursement for CPT 21320 by major payers:
$272.69
$331.28
$344.02
$379.87
| 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 21320 | ||||||
United | 21320 | $644.00 | 1780618801 - PINEY ORCHARD SURGERY CENTER, LLC. | 521938770 - (MD) PINEY ORCHARD SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $600.00 | 1780752352 - PREMIER SURGERY CENTER OF SANTA MARIA LLC | 203502741 - (CA) PREMIER SURGERY CENTER OF SANTA MARIA, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $515.00 | 1760778765 - GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK, LLC, TOWN LAKE ENDOSCOPY CENTER | 274193796 - (GA) GASTROINTESTINAL DIAGNOSTIC ENDOSCOPY WOODSTOCK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $1019.00 | 1215338868 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC, LAGUNA NIGUEL SURGERY CENTER | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $839.00 | 1376507194 - COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | 752528760 - (FL) COLUMBIA EYE AND SPECIALTY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $800.00 | 1083299747 - IRVING SPECIALISTS SURGICAL CENTER LLC | 852271899 - (TX) IRVING SPECIALISTS SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $735.00 | 1629173075 - THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC, CROWNE POINT ENDOSCOPY & SURGERY CENTER | 352227535 - (MI) THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $1258.00 | 1992250922 - MIAMI SURGICAL SUITES LLC | 474339341 - (FL) MIAMI SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $775.00 | 1104457274 - TEXAS MIDWEST ENDOSCOPY CENTER, LLC | 842574842 - (TX) TEXAS MIDWEST ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $2392.00 | 1104883784 - FORT WORTH ENDOSCOPY CENTERS, LLC, FORT WORTH ENDOSCOPY CENTER | 770368346 - (TX) FORT WORTH ENDOSCOPY CENTERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $1258.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $443.42 | 1396001103 - PEARL QUARTEY-KUMAPLEY | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 21320 | $509.00 | 1780292110 - BUCKEYE SOUTH LLC, BUCKEYE SURGERY CENTER | 832419523 - (AZ) BUCKEYE SOUTH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $2895.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21320 | $1374.00 | 1144380163 - THE CENTRE LLC | 352121237 | IN | 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 21320 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21320 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 21320 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) |
| 21325-CPT | Moderate | Open Treat Nasal Fracture Uncomplicated |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21320 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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