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See a sample rate comparisonCPT 21407 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.
Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout With Implant Open 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 LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21407 |
| Medicaid Fee Schedule | View Medicaid rates for 21407 |
National average reimbursement for CPT 21407 by major payers:
$917.06
$864.75
$896.19
$1,062.92
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CPT 21407
5 of 25 sample ratesHigher to lower in this preview
West Park Surgery Center, L.P., Medical City Surgery Center/Mckinney
West Park Surgery Center Lp
$6,685.00Published rateFranklin Endoscopy Center, LLC, Franklin Endoscopy Center
Franklin Endoscopy Center LLC
$5,020.00Published ratePsg Surgery Center LLC, Surgery Center Of Amarillo
Psg Surgery Center LLC
$2,800.00Published rateCherokee Farm Orthopedic Surgery Center, LLC
Cherokee Farm Orthopedic Surgery Center LLC
$2,000.00Published ratePain-Mds Ambulatory Surgical Center, LLC
Painmds Ambulatory Surgical Center LLC
$616.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21407 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21407 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 21407 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 |
|---|---|---|
| 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 |
| 21408-CPT | High | Open Treatment Of Fracture Of, Open Treatment Of Fracture Of Orbit Except Blowout With Bone Grafting (Includes Obtaining Graft)Open Treatment Of Fracture Of Orbit Except Blo Wout With |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21407. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21407 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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