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See a sample rate comparisonCPT 21401 Fee Schedule
Last Verified: October 2026
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.
Closed Treatment Of Fracture O, Closed Treatment Of Fracture Of Orbit Except Blowout With Manipulation Closed Treatment Of Fracture Of Orbit Except Blowout With
| 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 51 - Multiple procedures LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21401 |
| Medicaid Fee Schedule | View Medicaid rates for 21401 |
National average reimbursement for CPT 21401 by major payers:
$594.18
$652.41
$675.03
$536.38
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CPT 21401
5 of 25 sample ratesHigher to lower in this preview
Lake Spivey Ambulatory Surgery Care, LLC, Spivey Station Surgery Center
Emory University
$3,022.00Published rateNorthern Michigan Surgical Suites, LLC
$1,233.00Published rateDelray Beach Surgical Suites, LLC
Delray Beach Surgical Suites LLC
$765.00Published rateCentinela Valley Endoscopy Center Inc.
Centinela Valley Endoscopy Center Inc
$498.00Published rateLaser & Surgery Center Of Acadiana
Laser Surgery Center Of Acadiana
$357.00Published rate
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See a sample payer proposalCPT 21401 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21401 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 21401 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 |
|---|---|---|
| 21400-CPT | Moderate | Closed Treatment Of Fracture O, Closed Treatment Of Fracture Of Orbit Except Blowoutwithout Manipulation Closed Treatment Of Fracture Of Orbit Except Blowout |
| 21401-CPT | Moderate | Closed Treatment Of Fracture O, Closed Treatment Of Fracture Of Orbit Except Blowout With Manipulation Closed Treatment Of Fracture Of Orbit Except Blowout With |
| 21406-CPT | Moderate | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout Withoutimplant Open Treatment Of Fracture Of Orbit Except Blowout Without |
| 21407-CPT | Moderate | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout With Implant Open Treatment Of Fracture Of Orbit Except Blowout With |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21401. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21401 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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