CPT 21445 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 | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service KX - Requirements specified in the medical policy have been met |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21445 |
| Medicaid Fee Schedule | View Medicaid rates for 21445 |
National average reimbursement for CPT 21445 by major payers:
$980.02
$1,001.09
$1,048.39
$1,046.11
CPT 21445 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21445 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 21445 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 |
|---|---|---|
| 21440-CPT | Moderate | Closed Treatment Of Mandibular, Closed Treatment Of Mandibular Or Maxillary Alveolar Ridgefracture (Separate Procedure) Closed Treatment Of Mandibular Or Maxillary Alveolar Ridge |
| 21445-CPT | Moderate | Open Treatment Of Mandibular O, Open Treatment Of Mandibular Or Maxillary Alveolarridgefracture (Separate Procedure) Open Treatmen T Of Mandibular Or Maxillary Alveolar Ridge |
| 21450-CPT | Moderate | Closed Treatment Of Mandibular, Closed Treatment Of Mandibular Fracture Withoutmanipulation Closed Treatment Of Mandibular Fracture Without |
| 21451-CPT | Moderate | Closed Treatment Of Mandibular, Closed Treatment Of Mandibular Fracture With Manipulationclosed Treatment Of Mandibular Fracture With Manipulation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21445. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21445 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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