CPT 21552 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 21552 by major payers:
$576.43
$612.82
$637.23
$763.83
| 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 21552 | ||||||
United | 21552 | $1144.00 | 1780683797 - LOVELAND ENDOSCOPY CENTER, LLC, SKYLINE ENDOSCOPY CENTER | 421589159 - (CO) LOVELAND ENDOSCOPY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $1125.00 | 1184078503 - PIMA HEART ASC LLC, PIMA HEART ASC LLC | 812315336 - (AZ) PIMA HEART ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $2531.00 | 1972874907 - CAPITAL CITY SURGERY CENTER, LLC | 260804803 - (NC) CAPITAL CITY SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $2353.00 | 1972869881 - ADVANCED SURGERY CENTER OF BETHESDA, LLC | 454376136 - (MD) ASC BETHESDA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $4141.00 | 1487399168 - WILLOW PARK ENDOSCOPY CENTER, LLC | 881643733 - (TX) WILLOW PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $1127.00 | 1437113206 - ORLANDO SURGICARE LTD | 752375604 - (FL) ORLANDO SURGICARE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $2353.00 | 1134262868 - NORTH SHORE SAME DAY SURGERY LLC, NORTH SHORE SURGICAL CENTER | 364120432 - (IL) NORTH SHORE SAME DAY SURGERY LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $1490.00 | 1639682503 - SOUTH PLAINS SURGERY CENTER LLC | 822142398 - (TX) SOUTH PLAINS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $861.00 | 1336112200 - MERCER COUNTY SURGERY CENTER LLC, MERCER COUNTY SURGERY CENTER | 223774069 - (NJ) MERCER COUNTY SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $710.00 | 1770537698 - PHYSICIANS SURGERY CENTER OF FLORENCE LLC, PHYSICIANS SURGERY CENTER OF FLORENCE | 431983435 - (SC) QHG OF SOUTH CAROLINA INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $1625.00 | 1083169700 - FOUR PEAKS SURGERY CENTER, LLC | 813258200 - (AZ) FOUR PEAKS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $8705.00 | 1992395388 - IU HEALTH SOUTHWEST FORT WAYNE AMBULATORY SURGERY CENTER LLC, IU HEALTH SURGERY CENTER FORT WAYNE | 842206388 - (IN) IU HEALTH SOUTHWEST FORT WAYNE AMBULATORY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $2503.00 | 1821510579 - NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC, NOVANT HEALTH BRUNSWICK ENDOSCOPY | 820831203 - (NC) NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $1887.00 | 1730378498 - TORRANCE CA MULTISPECIALTY ASC LLC, SURGERY CENTER OF SOUTH BAY | 204259636 - (CA) TORRANCE CA MULTISPECIALTY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21552 | $2250.00 | 1003965328 - PACIFIC HEIGHTS SURGERY CENTER OF SAN FRANCISCO LP | 522380476 - (CA) PACIFIC HEIGHTS SURGERY CENTER | CA | 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 21552 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21552 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 21552 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 |
|---|---|---|
| 21552-CPT | Moderate | Exc Tumor Soft Tissue Neck Ant Thorax Subq 3 Cm |
| 21554-CPT | Moderate | Exc Tumor Soft Tissue Neck Thorax Subfasc 5 Cm |
| 21555-CPT | Moderate | Removal Of (Less Than 3 Centimeters) Tissue Growth Beneath The Skin Of Neck Or Front Of Chest |
| 21600-CPT | Moderate | Excision Rib Partial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21552. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21552 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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