CPT 21557 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21557 |
National average reimbursement for CPT 21557 by major payers:
$1,098.30
$1,182.27
$1,279.59
$1,516.37
| 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 21557 | ||||||
United | 21557 | $800.00 | 1669181822 - ALLIANCE SURGERY CENTER AT CUMMING | 881953675 - (GA) ALLIANCE SURGERY CENTER AT CUMMING | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $1258.00 | 1255373601 - CHESTERFIELD AMBULATORY SURGERY CENTER LP, CHESTERFIELD SURGERY CENTER | 203834076 - (MO) CHESTERFIELD AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $433.00 | 1679521389 - WESLEY & KLIPPENSTEIN, PC, WESLEY OPHTHALMIC PLASTIC SURGERY CENTER | 621799761 - (TN) WESLEY & KLIPPENSTEIN, P.C. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $445.00 | 1285874065 - WEST CHASE SURGERY CENTER LTD | 260167338 - (FL) WEST CHASE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $570.00 | 1801323191 - NS SURGICAL CENTER LLC | 814954399 - (KS) NS SURGICAL CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $600.00 | 1437691177 - FRESENIUS VASCULAR CARE CINCINNATI ASC LLC, AZURA SURGERY CENTER CINCINNATI | 814225843 - (OH) FRESENIUS VASCULAR CARE CINCINNATI ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $1258.00 | 1619637543 - GAB ENDOSCOPY CENTER LLC | 372021101 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $578.00 | 1093764045 - GASTROENTEROLOGY OF INDIANAPOLIS PC, DIGESTIVE HEALTH CENTER | 351641181 - (IN) GASTROENTEROLOGY OF INDIANAPOLIS, P . C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $2889.00 | 1174165237 - RIVER RIDGE SURGICAL SUITES, LLC | 833741084 - (IN) RIVER RIDGE SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $453.00 | 1295086049 - WOMENS CENTER FOR ADVANCED SURGERY INC | 454798001 - (GA) WOMENS CENTER FOR ADVANCED SURGERY INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $1082.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $467.00 | 1376592204 - PALMETTO ENDOSCOPY CENTER LLC | 571195554 - (SC) PALMETTO ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $1233.00 | 1366449571 - SHORE OUTPATIENT SURGICENTER LLC | 582252127 - (NJ) SHORE OUTPATIENT SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $438.00 | 1487239059 - AAU GREENBELT ASC LLC | 862166420 - (MD) AAU GREENBELT ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21557 | $1061.00 | 1952353187 - MCKENZIE SURGERY CENTER LP | 621600267 - (OR) MCKENZIE SURGERY CENTER LP | OR | 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 21557 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21557 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 21557 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 |
|---|---|---|
| 21557-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Neck Or Anterior Thorax; Less Than 5 Cm (Revised 01/01/2014) |
| 21558-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Neck Or Anterior Thorax; 5 Cm Or Greater(Revised 01/01/2014) |
| 21600-CPT | Moderate | Excision Rib Partial |
| 21601-CPT | High | Removal Of Tumor From Chest Wall Including Ribs |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21557. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21557 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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