CPT 21355 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 | • 21 - Inpatient Hospital • 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 21355 |
National average reimbursement for CPT 21355 by major payers:
$560.20
$568.40
$593.65
$725.83
| 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 21355 | ||||||
United | 21355 | $709.00 | 1992700090 - TAMPA BAY SPECIALTY SURGERY CENTER LLC, TAMPA BAY SPECIALTY SURGERY CENTER | 331019420 - (FL) TAMPA BAY SPECIALTY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $3003.00 | 1467979443 - MVH ENDOSCOPY LLC, PCS ENDOSCOPY SUITE | 822606374 - (ID) MVH ENDOSCOPY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $3100.00 | 1487158796 - CENTRIC AMBULATORY SURGERY CENTER LLC | 824465250 - (MO) CENTRIC AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $1001.00 | 1033162631 - EYE SURGERY CENTER-NORTHLAND LLC | 201938574 - (MO) EYE SURGERY CENTERNORTHLAND LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $3265.00 | 1306375837 - CENTRAL COAST CARDIOVASCULAR ASC LLC | 821736669 - (CA) CENTRAL COAST CARDIOVASCULAR ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $2163.00 | 1154034429 - CROSSINGS SURGERY CENTER, LLC | 472361569 - (RI) ORTHOPEDICS RHODE ISLAND, INC. | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $2978.00 | 1871939082 - RAYMOND RENAISSANCE SURGERY CENTER LLC | 462035014 - (CA) RAYMOND RENAISSANCE SURGERY CE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $4194.00 | 1427471911 - NORTHWOODS SURGERY CENTER LLC | 462454295 - (MN) NORTHWOODS SURGERY CENTER, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $5249.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $4014.00 | 1508438375 - BSC REID PARK LLC | 870858924 - (AZ) BSC REID PARK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $2644.00 | 1316341514 - MIAMI CHILDREN'S HOSPITAL AMBULATORY SURGERY CENTER, LLC | 463406805 - (FL) MIAMI CHILDRENS HOSPITAL AMBULA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $13828.00 | 1154375475 - COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP, MEDICAL CITY NORTH HILLS | 621682205 - (TX) COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $4671.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $1783.00 | 1194291401 - AFFILIATED PHYSICIANS & SURGEONS, LTD | 860495569 - (AZ) AFFILIATED PHYSICIANS SURGEONS LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21355 | $5020.00 | 1649515354 - SURGCENTER NORTHEAST LLC | 455554995 - (FL) SURGCENTER NORTHEAST, 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 21355 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21355 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 21355 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 |
|---|---|---|
| 21340-CPT | High | Percutaneous Treatment Of Nasoethmoid Complex Fracture, With Splint, Wire Or Headcap Fixation, Including Repair Of Canthal Ligaments And/Or The Nasolacrimal Apparatus |
| 21355-CPT | Moderate | Red Fx-Malar Towel Clip |
| 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 21355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21355 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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