CPT 21423 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 • 51 - Multiple procedures • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21423 |
National average reimbursement for CPT 21423 by major payers:
$1,003.03
$1,054.98
$1,102.34
$1,333.70
| 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 21423 | ||||||
United | 21423 | $1050.00 | 1518379205 - IPS ASC, LLC, GEMINI SURGERY CENTER | 465227049 - (OH) IPS ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $2600.00 | 1902852841 - MIDTOWN UROLOGY SURGICAL CENTER, PC | 582022094 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $2200.00 | 1871026120 - ACCESS CARE PHYSICIANS OF NJ LLC | 203639484 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $1605.00 | 1316976137 - CENTRAL MARYLAND ENDOSCOPY LLC | 201580201 - (MD) CENTRAL MARYLAND ENDOSCOPY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $4703.00 | 1164513149 - ENDO-SURGI OF UNION ASC LLC | 223248249 - (NJ) ENDO-SURGI CENTER, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $5241.00 | 1225568884 - WAKE FOREST AMBULATORY VENTURES, LLC | 820777206 - (NC) WAKE FOREST AMBULATORY VENTURES LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $1721.00 | 1316969058 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $4000.00 | 1013104389 - TRACY SURGERY CENTER, LLC, TRACY SURGERY CENTER, LLC | 203762687 - (CA) TRACY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $741.00 | 1992423719 - ENDOSCOPY ASC OF MIDDLE GEORGIA LLC | 883065469 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $1500.00 | 1558844183 - MIDDLEBURG SURGERY CENTER LLC | 831229418 - (FL) MIDDLEBURG SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $5249.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $2111.00 | 1013612423 - ARLINGTON HEIGHTS SURGERY CENTER, LLC | 301341813 - (IL) ARLINGTON HEIGHTS SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $4500.00 | 1477695336 - SOMERSET OUTPATIENT SURGERY, LLC, RARITAN VALLEY SURGERY CENTER | 208433398 - (NJ) SOMERSET OUTPATIENT SURGERY, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $2100.00 | 1588663512 - THOMAS EYE SURGERY CENTER LLC | 582464498 - (GA) THOMAS EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21423 | $5433.00 | 1366444929 - EAST WEST SURGERY CENTER LP | 621797897 - (GA) EAST WEST SURGERY CENTER LP | GA | 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 21423 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21423 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 21423 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 |
|---|---|---|
| 21421-CPT | Moderate | Closed Treatment Of Palatal Or Maxillary Fracture (Lefort I Type), With Interdental Wire Fixation Or Fixation Of Denture Or Splint |
| 21422-CPT | Moderate | Open Lefort I Fract |
| 21423-CPT | High | Open Treatment Of Palatal Or Maxillary Fracture (Lefort I Type); Complicated (Comminuted Or Involving Cranial Nerve Foramina), Multiple Approaches |
| 21432-CPT | Moderate | Red Fx Open-Lefort 3 Type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21423. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21423 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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