CPT 21470 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 • 50 - Bilateral Procedure • GC - Service performed by resident under supervision |
| Complexity Level | High |
National average reimbursement for CPT 21470 by major payers:
$1,634.10
$1,589.02
$1,714.59
$1,976.32
| 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 21470 | ||||||
United | 21470 | $3672.00 | 1780871319 - SURGICAL SPECIALISTS ASC, LLC | 208066886 - (FL) SURGICAL SPECIALISTS ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $3495.00 | 1366536880 - SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC | 911959910 - (WA) SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $8387.00 | 1063442077 - INOVA LOUDOUN AMBULATORY SURGERY | 203523190 - (VA) INOVA LOUDOUN AMBULATORY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $940.00 | 1003888595 - LOUISVILLE ENDOSCOPY CENTER, PLLC, LOUISVILLE ENDOSCOPY CENTER | 611354100 - (KY) LOUISVILLE ENDOSCOPY CENTER PLLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $1890.00 | 1598809758 - CALIFORNIA EYE CLINIC | 680024090 - (CA) CALIFORNIA EYE CLINIC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $961.00 | 1023153160 - INNOVIA SURGERY CENTER, LLC, ADVANTAGE HEALTHCARE | 364167589 - (IL) INNOVIA SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $5249.00 | 1154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC | 833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $2917.00 | 1073578019 - BLUE RIDGE DAY SURGERY CENTER, LP, BLUE RIDGE DAY SURGERY CENTER | 621530122 - (NC) BLUE RIDGE DAY SURGERY CENTER LP | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $2888.00 | 1922729847 - PARDEE AMBULATORY SURGERY CENTER LLC, THE SURGERY CENTER AT MILLS RIVER | 853190133 - (NC) PARDEE AMBULATORY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $5020.00 | 1356307565 - AMBULATORY SURGICAL ASSOCIATES LLC, TULLAHOMA SURGERY CENTER | 61658016 - (TN) AMBULATORY SURGICAL ASSOCIATES LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $2346.00 | 1477645711 - PROGRESSIVE SURGERY CENTER LLC | 20685569 - (NY) PROGRESSIVE SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $1500.00 | 1811028293 - IEC SURGICAL CENTERS LLC, PHYSICIANS SURGERY CENTER | 204233454 - (MO) IEC SURGICAL CENTERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $2359.00 | 1700843208 - FAYETTEVILLE AMBULATORY SURGERY CENTER LIMITED PARTNERSHIP, FAYETTEVILLE AMBULATORY SURGERY CENTER | 561754482 - (NC) FAYETTEVILLE AMBULATORY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $1800.00 | 1699328146 - ALLIANCE SURGERY CENTER, LLC | 824278461 - (MI) ALLIANCE SURGERY CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21470 | $4625.00 | 1629703236 - NORTH CYPRESS SURGICENTER, LLC, NORTH CYPRESS SURGERY CENTER | 851383722 - (TX) NORTH CYPRESS SURGICENTER LLC | TX | 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 21470 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21470 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 21470 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 21470. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21470 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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