CPT 21461 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21461 |
National average reimbursement for CPT 21461 by major payers:
$2,192.93
$2,549.75
$2,590.12
$3,053.93
| 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 21461 | ||||||
United | 21461 | $2496.00 | 1235760406 - STAR SURGERY CENTER, LLC | 823216301 - (AZ) STAR SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $4561.00 | 1174165237 - RIVER RIDGE SURGICAL SUITES, LLC | 833741084 - (IN) RIVER RIDGE SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $2051.00 | 1558053868 - LORAIN AMHERST SURGERY CENTER LLC | 853470191 - (OH) LORAIN AMHERST SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $736.00 | 1104899855 - SOUTHFIELD ENDOSCOPY ASC LLC, GASTROINTESTINAL ENDOSCOPY CENTER | 943421929 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $3289.00 | 1912199258 - SURGICARE SURGICAL ASSOCIATES OF RIDGEWOOD, LLC | 203728835 - (NJ) SURGICARE SURGICAL ASSOCIATES OF RIDGEWOOD LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $7121.00 | 1487039517 - KC PAIN ASC, LLC | 464510621 - (MO) KC PAIN ASC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $1800.00 | 1588062400 - EAR NOSE AND THROAT SURGERY CENTER LLC | 464525209 - (NV) EAR NOSE AND THROAT SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $520.00 | 1568556488 - SUNCOAST EYE CENTER PA, SUNCOAST SURGERY INSTITUTE | 592337219 - (FL) SUNCOAST EYE CENTER PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $4530.00 | 1932234853 - ARIA HEALTH BUCKS COUNTY SPU | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $1258.00 | 1689669418 - DIAGNOSTIC ENDOSCOPY LLC | 223750394 - (CT) DIAGNOSTIC ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $3686.00 | 1033154851 - PARKWEST SURGERY CENTER LP | 621808841 - (TN) PARKWEST SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $2898.00 | 1497788277 - PACIFIC EYE SURGERY CENTER, PACIFIC SURGERY CENTER | 954200314 - (CA) PACIFIC EYE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $5002.00 | 1619265295 - KINGWOOD SURGERY CENTER LLC | 621771718 - (TX) KINGWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21461 | $3638.27 | 1962076034 - VARINDER BANSRO | 350593390 - DEACONESS HOSPITAL INC | MD | Internal Medicine Physician (207R00000X) |
United | 21461 | $3484.00 | 1578534459 - BOSTON OUT-PATIENT SURGICAL SUITES, LLC | 270050256 - (MA) BOSTON OUT-PATIENT SURGICAL SUITES, LLC | MA | 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 21461 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21461 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 21461 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 |
|---|---|---|
| 21461-CPT | High | Open Mandible Fract Wo Int Fix |
| 21462-CPT | High | Red Fx Open-Mandible W Interdent |
| 21465-CPT | High | Open Treat Mandibular Condylar Frac |
| 21470-CPT | High | Open Treatment Of Complicated Mandibular Fracture By Multiple Surgical Approaches Including Internal Fixation, Interdental Fixation, And/Or Wiring Of Dentures Or Splints |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21461 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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