CPT 21554 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 • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 21554 by major payers:
$925.22
$1,004.65
$1,040.56
$1,242.82
| 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 21554 | ||||||
United | 21554 | $748.00 | 1588802987 - NATIONAL PARK ENDOSCOPY CENTER, LLC, SOUTH CENTRAL ENDOSCOPY | 900881332 - (AR) NATIONAL PARK ENDOSCOPY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $4258.00 | 1699702050 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON BELLEVUE ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $4617.00 | 1528479664 - HHC SOUTHINGTON SURGERY CENTER, LLC, CHESHIRE SURGERY CENTER | 465500829 - (CT) HHC SOUTHINGTON SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $1800.00 | 1982931465 - GARDEN GROVE SURGICAL CENTER INC | 271203227 - (CA) GARDEN GROVE SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $485.00 | 1952373086 - CRYSTAL RIVER ENDOSCOPY ASC LP, CITRUS ENDOSCOPY & SURGERY CENTER | 621666148 - (FL) CRYSTAL RIVER ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $3209.00 | 1992459978 - OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER, OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER DUBLIN | 854149946 - (OH) OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $1420.00 | 1730374307 - NORTHVIEW ORTHOPAEDIC SURGERY CENTER, P.C. | 261245423 - (GA) NORTHVIEW ORTHOPAEDIC SURGERY CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $2087.00 | 1710688627 - BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | 922359229 - (KY) BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $1525.00 | 1669720397 - PLEASANT VIEW SURGERY CENTER, LLC | 455254219 - (ID) PLEASANT VIEW SURGERY CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $1056.00 | 1083144653 - GREATER PITTSBURGH SURGERY LLC | 821512721 - (PA) GREATER PITTSBURGH SURGERY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $8705.00 | 1609052679 - BELTWAY SURGERY CENTERS, LLC, BELTWAY SURGERY CENTER SPRINGMILL | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $2353.00 | 1871032680 - OLIVE AMBULATORY SURGERY CENTER, LLC, NORTH CAMPUS SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $1283.00 | 1093757379 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $748.00 | 1073601332 - LISA RENFRO SURGERY CENTER LLC | 43612312 - (MD) LISA RENFRO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21554 | $3344.00 | 1861825986 - VADNAIS HEIGHTS SURGERY CENTER LLC, VADNAIS HEIGHTS SURGERY CENTER | 371866891 | MN | 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 21554 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21554 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 21554 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 |
| 21556-CPT | Moderate | Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subfascial (Eg, Intramuscular); Less Than 5 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21554. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21554 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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