CPT 21366 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | High |
| Medicare Fee Schedule | View Medicare rates for 21366 |
National average reimbursement for CPT 21366 by major payers:
$1,692.53
$1,686.83
$1,712.39
$2,098.56
| 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 21366 | ||||||
United | 21366 | $2227.00 | 1659609311 - RIVERLAKES SURGERY CENTER LLC | 270493977 - (CA) RIVERLAKES SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1425.00 | 1780747394 - MORRIS AVENUE ENDOSCOPY LLC | 223651957 - (NJ) MORRIS AVENUE ENDOSCOPY, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $893.00 | 1710047188 - ARROWHEAD ENDOSCOPY AND PAIN MANAGEMENT CENTER LLC, ARROWHEAD ENDOSCOPY CENTER. | 205706445 - (AZ) ARROWHEAD ENDOSCOPY AND PAIN MAN | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $3486.00 | 1881717627 - SHAH ASSOCIATES MD PA, TRI-COUNTY ENDOSCOPY CENTER | 462691028 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1665.00 | 1790744175 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, PUYALLUP ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1450.00 | 1457354300 - SURGERY CENTER OF OCALA LLC | 621808594 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $753.00 | 1972214682 - CEI PHYSICIANS PSC, LLC | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1204.00 | 1346308962 - PODIATRY ASSOCIATES AMBULATORY SURGICAL CENTERS LLC | 522210174 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $5354.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $3512.00 | 1093230450 - CENTER FOR UROLOGIC SURGERY LLC | 822344535 - (MO) CENTER FOR UROLOGIC SURGERY LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $8238.00 | 1093120859 - PARK HILL SURGERY CENTER, LLC | 451484375 - (TX) PARK HILL SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1144.00 | 1497750426 - NEW ALBANY OUTPATIENT SURGERY, LLC, SURGICAL CENTER OF NEW ALBANY | 232722876 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1805.00 | 1750414983 - ROCKLEDGE SURGERY CENTER, INC. | 522098503 - (MD) ROCKLEDGE SURGERY CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $1495.00 | 1649511577 - THE SURGERY CENTER AT ORTHOPEDIC ASSOCIATES, LLC | 461267019 - (NY) THE SURGERY CENTER AT ORTHOPEDIC ASSOCIATES LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21366 | $4017.00 | 1255991238 - LEE SUMMIT ASC KC LLC, BEACON SURGERY CENTER | 831077983 - (MO) LEE SUMMIT ASC KC LLC | MO | 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 21366 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21366 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 21366 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 |
| 21366-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 Bone Grafting (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21366. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21366 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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