CPT 21431 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 • 11 - Office |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21431 |
National average reimbursement for CPT 21431 by major payers:
$883.50
$944.14
$960.35
$1,186.31
| 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 21431 | ||||||
United | 21431 | $550.00 | 1265434740 - SALLY K BALIN AMBULATORY SURGICAL CENTER INC | 232969046 - (PA) SALLY K BALIN AMBULATORY SURGICAL CENTER INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $1374.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2270.00 | 1558787614 - DIGESTIVE CARE ENDOSCOPY | 464923646 - (GA) DIGESTIVE CARE ENDOSCOPY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $3162.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $8327.00 | 1760035158 - LEIGH ORTHOPEDIC SURGERY CENTER, LLC | 832402528 - (VA) LEIGH ORTHOPEDIC SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $5354.00 | 1942264619 - METROPOLITAN MEDICAL PARTNERS LLC, SURGERY CENTER OF CHEVY CHASE | 522303928 - (MD) METROPOLITAN MEDICAL PARTNERS LL | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $3393.00 | 1174030878 - STUART SURGERY CENTER, LLC | 822542219 - (FL) STUART SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $5903.00 | 1841444593 - TEANECK SURGICAL CENTER, LLC | 10776897 - (NJ) TEANECK SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $5354.00 | 1104485440 - SURGCENTER OF GREATER JACKSONVILLE, LLC | 832504492 - (FL) SURGCENTER OF GREATER JACKSONVILLE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2309.00 | 1992192488 - WEST PACES SURGERY CENTER LLC | 473360333 - (GA) WEST PACES SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $702.00 | 1942242441 - ADVANCED EYE SURGERY CENTER, LLC | 510567447 - (FL) ADVANCED EYE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2500.00 | 1487096061 - ARETE SURGICAL CENTER, LLC | 455436298 - (CO) ARETE SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2814.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2937.00 | 1154322410 - SUMMIT SURGICAL SUITES, LLC, SOUTHWEST SURGICAL SUITES | 383641574 - (IN) SUMMIT SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21431 | $2460.00 | 1215245238 - AMERICAN ACCESS CARE OF NEW JERSEY, LLC, AZURA SURGERY CENTER CHERRY HILL | 223783657 - (NJ) AMERICAN ACCESS CARE OF NEW JERSEY LLC | NJ | 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 21431 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21431 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 21431 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 | Close Orbit Fract Wo Manip |
| 21431-CPT | Moderate | Close Lefort Iii W Wire Fix |
| 21432-CPT | Moderate | Red Fx Open-Lefort 3 Type |
| 21433-CPT | High | Open Treatment Of Craniofacial Separation (Lefort Iii Type); Complicated (Eg, Comminuted Or Involving Cranial Nerve Foramina), 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 21431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21431 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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