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See a sample rate comparisonCPT 21558 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.
Radical Resection Of Tumor (Eg, Radical Resection Of Tumor (Eg Malignant Neoplasm) Soft Tissue Of Neck Or Anterior Thorax 5 Cm Orgreater
| 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 GC - Service performed by resident under supervision 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21558 |
| Medicaid Fee Schedule | View Medicaid rates for 21558 |
National average reimbursement for CPT 21558 by major payers:
$1,656.71
$1,858.01
$1,866.44
$2,214.37
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CPT 21558
5 of 25 sample ratesHigher to lower in this preview
Basalt Orthopedic Surgery Center, LLC, Bosc
Basalt Orthopedic Surgery Center LLC
$7,328.00Published rateNorth Haven Surgery Center LLC, North Haven Pain Medicine Center, LLC
North Haven Surgery Center LLC
$2,388.00Published rateCares Ambulatory Surgery Services
$1,687.00Published rateSouthern Plains Medical Center Spmc-Asc, Spmc-Asc
Southern Plains Medical Center Spmcasc
$980.00Published rateMei Surgery Center LLC, Michigan Eye Surgery Center
Mei Surgery Center LLC
$490.00Published rate
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See a sample payer proposalCPT 21558 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21558 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 21558 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, Radical Resection Of Tumor (Eg Malignant Neoplasm) Soft Tissue Of Neck Or Anterior Thorax Less Than 5 Cm |
| 21558-CPT | High | Radical Resection Of Tumor (Eg, Radical Resection Of Tumor (Eg Malignant Neoplasm) Soft Tissue Of Neck Or Anterior Thorax 5 Cm Orgreater |
| 21601-CPT | High | Surgery For Chest Tumor, Surgery On The Chest To Remove A Tumor Including Nearby Ribs That May Be Involved. |
| 21602-CPT | High | Surgery For Chest Tumor, Surgery On The Chest To Remove A Tumor Including Nearby Ribs That May Be Involved. The Surgery Can Include Reconstruction Of Ribs And Removal Of Affected Lymph Nodes. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21558. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21558 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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