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See a sample rate comparisonCPT 21616 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.
Surgery To Remove A Rib, Surgery To Remove The First Rib. If There Is An Extra Rib Above The First Rib In The Neck (Cervical Rib) It Will Be Removed As Well.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21616 |
| Medicaid Fee Schedule | View Medicaid rates for 21616 |
National average reimbursement for CPT 21616 by major payers:
$1,062.86
$1,030.89
$1,009.94
$1,191.64
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CPT 21616
5 of 25 sample ratesHigher to lower in this preview
Inova Woodburn Surgery Center LLC
Inova Health Care Services
$9,317.00Published ratePalm Beach International Surgery Center LLC, Palm Beach International Surgery Center At The Paley Institute
Palm Beach International Surgery Center LLC
$6,087.00Published rateMontgomery Surgical Center, Ltd
Montgomery Surgical Center Ltd
$4,665.00Published rateNorth Oak Ambulatory Surgery Center, LLC
$3,200.00Published rateSonterra Procedure Center, LLC
Sonterra Procedure Center LLC
$1,130.00Published rate
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See a sample payer proposalCPT 21616 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21616 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 21616 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 |
|---|---|---|
| 21610-CPT | High | Costotransversectomy (Sep Proc) |
| 21615-CPT | Moderate | Surgery To Remove A Rib, Surgery To Remove The First Rib. If There Is An Extra Rib Above The First Rib In The Neck (Cervical Rib) It Will Be Removed As Well. |
| 21616-CPT | High | Surgery To Remove A Rib, Surgery To Remove The First Rib. If There Is An Extra Rib Above The First Rib In The Neck (Cervical Rib) It Will Be Removed As Well. |
| 21620-CPT | Moderate | Ostectomy Sternum Partial |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21616 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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