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See a sample rate comparisonCPT 21499 Fee Schedule
Last Verified: October 2026
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.
Unlisted Musculoskele Proc Head, Unlisted Musculoskeletal Procedure Head
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 51 - Multiple procedures LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21499 |
| Medicaid Fee Schedule | View Medicaid rates for 21499 |
National average reimbursement for CPT 21499 by major payers:
$1,181.44
$142.89
$8,000.00
$1,111.31
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CPT 21499
5 of 25 sample ratesHigher to lower in this preview
Surgical Center At Cedar Knolls LLC
Surgical Center At Cedar Knolls
$2,028.00Published rateAustin Gi Surgicenter, LLC, Austin Endoscopy Center
Austin Gi Surgicenter LLC
$627.00Published rateUnited Shockwave Services, Ltd., United Therapies
$355.00Published rateBay Area Laser Surgery Center, A Medical Corporation
Bay Area Laser Surgery Center A Medical Corporation
$135.00Published rateVisionary Surgery Center Of Nevada, LLC
Visionary Surgery Center Of Nevada LLC
$92.00Published rate
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See a sample payer proposalCPT 21499 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21499 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 21499 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 |
|---|---|---|
| 21470-CPT | High | Open Treatment Of Complicated, Open Treatment Of Complicated Mandibular Fracture Bymultiple Surgical Approaches Including Internal Fixation Interdental Fixation Andor Wiring Of Dentures Or Splints |
| 21499-CPT | High | Unlisted Musculoskele Proc Head, Unlisted Musculoskeletal Procedure Head |
| 21501-CPT | Moderate | Incision And Drainage Deep Ab, Incision And Drainage Deep Abscess Or Hematoma Softtissues Of Neck Or Thorax Incision And Drainage Deep Abscess Or Hematoma Soft |
| 21510-CPT | Moderate | Ncision Deep W/ Open Of Bone Cortex (Eg For Osteomyeli Or, Incision Deep With Opening Of Bone Cortex (Eg For Osteomyelitis Or |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21499 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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