CPT 21499 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 | • 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 |
National average reimbursement for CPT 21499 by major payers:
$1,181.44
$142.89
$8,000.00
$1,131.26
| 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 21499 | ||||||
United | 21499 | $627.00 | 1205327277 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $200.00 | 1376269324 - THE SURGEON'S POINT SURGERY CENTER, LLC, THE SURGEON'S POINT AT CEDAR PARK | 301282509 - (TX) THE SURGEONS POINT SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $963.00 | 1740231489 - STONEGATE SURGERY CENTER LP | 201211544 - (TX) STONEGATE SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $703.00 | 1497120588 - SUMMIT ORTHOPEDICS, LTD, PLYMOUTH SURGERY CENTER | 411762331 - SUMMIT ORTHOPEDICS, LTD. | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $135.00 | 1750582797 - BAY AREA LASER SURGERY CENTER, A MEDICAL CORPORATION | 208712646 - (CA) BAY AREA LASER SURGERY CENTER A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $123.00 | 1346386604 - DIGESTIVE HEALTH CENTER LLC | 341955920 - DIGESTIVE HEALTH CENTER, LTD. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $138.00 | 1023005600 - PSHS BETA PARTNERS LTD, THE GABLES SURGICAL CENTER | 650848650 - (FL) PSHS BETA PARTNERS LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $1026.00 | 1457379158 - HUDSON CROSSING SURGERY CENTER, LLC, HUDSON CROSSING SURGERY CENTER | 364533553 - (NJ) HUDSON CROSSING SURGICAL CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $566.00 | 1366684326 - PRINCE FREDERICK SURGERY CENTER LLC | 264387021 - (MD) PRINCE FREDERICK SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $874.00 | 1861538613 - CENTRACARE SURGERY CENTER, LLC | 611514974 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $160.00 | 1427307578 - HEMLOCK AMBULATORY SURGERY CENTER | 455511791 - (GA) HEMLOCK AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $131.00 | 1578918124 - CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | 811657416 - (ND) CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $375.00 | 1023015989 - TUCSON GASTROENTEROLOGY INSTITUTE, LLC | 860966257 - (AZ) TUCSON GASTROENTEROLOGY INSTITUTE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $500.00 | 1215410592 - ALLIANCE SURGERY CENTER AT WOODSTOCK, LLC | 830957221 - (GA) ALLIANCE SURGERY CENTER AT WOODSTOCK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21499 | $355.00 | 1114312659 - UNITED SHOCKWAVE SERVICES, LTD., UNITED THERAPIES | 363415474 | IL | 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 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 Mandibular Fracture By Multiple Surgical Approaches Including Internal Fixation, Interdental Fixation, And/Or Wiring Of Dentures Or Splints |
| 21499-CPT | High | Other Procedure On Head Muscle Or Head Bone |
| 21501-CPT | Moderate | I&D Deep Soft Tiss Neck/Thorax |
| 21510-CPT | Moderate | Incis Deep W/Open Cortex Thorax |
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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