CPT 21436 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 • 11 - Office |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 50 - Bilateral Procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21436 |
National average reimbursement for CPT 21436 by major payers:
$2,372.18
$2,711.51
$2,743.29
$3,356.04
| 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 21436 | ||||||
United | 21436 | $1039.00 | 1801811773 - DUPAGE EYE SURGERY CENTER, LLC | 920189811 - (IL) DUPAGE EYE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $3877.00 | 1548984263 - ALLINA HEALTH SURGERY CENTER | 883732480 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $8440.00 | 1649482449 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $1100.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 463285029 - (GA) CENTER FOR PAIN AND SPINE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $10317.00 | 1548400070 - COMMUNITY ENDOSCOPY CENTER LLC | 611464136 - (IN) COMMUNITY ENDOSCOPY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $2145.00 | 1831116698 - LASER AND OUTPATIENT SURGERY CENTER LLC | 201098451 - (FL) LASER AND OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $1545.00 | 1558328518 - BUTLER AMBULATORY SURGERY CENTER L L C | 61728190 - (PA) BUTLER AMBULATORY SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $1969.40 | 1275184293 - JOHNS HOPKINS SURGERY CENTERS SERIES, BEL AIR SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $2790.00 | 1467499293 - ST CLOUD MN OPHTHALMOLOGY ASC LLC, ST. CLOUD CENTER FOR OPHTHALMIC SURGERY | 203853072 - (MN) ST CLOUD MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $7191.00 | 1225064736 - NMC SURGERY CENTER, L.P., THE SURGERY CENTER OF NACOGDOCHES | 752793512 - (TX) NMC SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $3100.00 | 1629256961 - BELMONT/HARLEM SURGERY CENTER, LLC | 412237612 - (IL) BELMONT/HARLEM SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $7733.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $2500.00 | 1770147217 - ANDOVER AMBULATORY SURGERY CENTER, LLC | 830649332 - (KS) ANDOVER AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $1471.00 | 1891724936 - ARKLAMISS SURGERY CENTER,LLC | 870741444 - (LA) ARKLAMISS SURGERY CENTERLLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21436 | $3700.00 | 1689173981 - MAO LEAWOOD SURGERY CENTER LLC | 812903525 - (KS) MAO LEAWOOD SURGERY CENTER LLC | KS | 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 21436 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21436 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 21436 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 |
|---|---|---|
| 21423-CPT | High | Open Treatment Of Palatal Or Maxillary Fracture (Lefort I Type); Complicated (Comminuted Or Involving Cranial Nerve Foramina), Multiple Approaches |
| 21431-CPT | Moderate | Close Lefort Iii W Wire Fix |
| 21432-CPT | Moderate | Red Fx Open-Lefort 3 Type |
| 21436-CPT | High | Open Treatment Of Craniofacial Separation (Lefort Iii Type); Complicated, Multiple Surgical Approaches, Internal Fixation, 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 21436. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21436 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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