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See a sample rate comparisonCPT 21742 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.
Repair Stern Nuss W O Scope, Reconstructive Repair Of Pectus Excavatum Or Carinatum Minimally Invasive Approach Nuss Procedure Without Thoracoscopy
| 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 82 - Assistant surgeon - no qualified resident 51 - Multiple procedures 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21742 |
| Medicaid Fee Schedule | View Medicaid rates for 21742 |
National average reimbursement for CPT 21742 by major payers:
$1,644.23
$1,370.25
$1,491.57
$1,812.72
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CPT 21742
5 of 25 sample ratesHigher to lower in this preview
Trident Ambulatory Surgery Center, L.P.
Trident Ambulatory Surgery Center Lp
$7,733.00Published rateAmarillo Endoscopy Center, Lp
Amarillo Endoscopy Center Lp
$5,249.00Published rateNorth Mississippi Ambulatory Surgery Center LLC
$2,890.00Published rateI Care Center LLC, Central Indiana Surgery Center
Icare Center Dba Central Indiana Surgery Center, LLC
$1,745.00Published rateVision Institute Of Michigan Surgery Center PC, Surgery Center Of Michigan
$731.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21742 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21742 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 21742 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 |
|---|---|---|
| 21725-CPT | Moderate | Divisi Of Sternocleidomasto For Torticollis Open Opera; W/, Division Of Sternocleidomastoid For Torticollis Open Operation; With |
| 21740-CPT | High | Chest Reconstructive Surgery, Surgery To Correct Bone Growth That Has Resulted In The Breastbone Caving Inward Or Pushing Outward. |
| 21742-CPT | High | Repair Stern Nuss W O Scope, Reconstructive Repair Of Pectus Excavatum Or Carinatum Minimally Invasive Approach Nuss Procedure Without Thoracoscopy |
| 21743-CPT | High | Repair Sternum Nuss W Scope, Reconstructive Repair Of Pectus Excavatum Or Carinatum Minimally Invasive Approach Nuss Procedure With Thoracoscopy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21742. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21742 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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