CPT 21812 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 | • 21 - Inpatient Hospital • 23 - Emergency Room • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 21812 by major payers:
$962.07
$1,011.07
$1,014.05
$1,196.02
| 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 21812 | ||||||
United | 21812 | $4386.00 | 1346792165 - HSS ASC OF MANHATTAN LLC, HSS ASC OF MANHATTAN | 471353602 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $1056.00 | 1548249675 - ENDOSCOPY CENTER OF SANTA FE LP, THE ENDOSCOPY CENTER OF SANTA FE | 621548645 - (NM) ENDOSCOPY CENTER OF SANTA FE LP | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $549.00 | 1801993217 - EYE PHYSICIANS OF SUSSEX COUNTY, EYE PHYSICIANS OF SUSSEX COUNTY SURGICAL SUITE | 222172159 - (NJ) EYE PHYSICIANS OF SUSSEX COUNTY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $811.00 | 1205963568 - BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | 231714249 - (PA) BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $920.00 | 1720752629 - BAY SURGERY CENTERS | 453365193 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $611.00 | 1649233719 - GI ASC LLC | 861122720 - (PA) GI ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $818.00 | 1992701049 - NORTHWEST FLORIDA SURGERY CENTER | 593123289 - (FL) NORTHWEST FLORIDA SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $3599.00 | 1558328096 - NEWPORT BEACH ENDOSCOPY CENTER, LLC | 770368744 - (CA) NEWPORT BEACH ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $614.00 | 1063408649 - AIMS OUTPATIENT SURGERY | 860751146 - (AZ) AIMS OUTPATIENT SURGERY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $600.00 | 1629016076 - UNIVERSITY CENTER FOR AMBULATORY SURGERY, LLC, UCAS, LLC | 522149129 - UNIVERSITY CENTER FOR AMBULATORY SURGERY, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $638.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $1445.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $2388.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $3871.00 | 1104947357 - TARRANT COUNTY SURGERY CENTER LP | 710985084 - (TX) TARRANT COUNTY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21812 | $1535.00 | 1922230853 - CRYSTAL RUN AMBULATORY SURGERY CENTER OF MIDDLETOWN, LLC | 270476822 - (NY) CRYSTAL RUN AMBULATORY SURGERY CENTER OF MIDDLETOWN, LLC | NY | 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 21812 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21812 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 21812 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 |
|---|---|---|
| 21750 | Moderate | Close Sternotomy Separation W/Wo Debride |
| 21811 | Moderate | Once Per Dos Open Treatment Of Rib Fracture W/Internal Fixation, Includes Thoracoscopic Visualization When Performed; Unilateral 1-2 Ribs |
| 21812 | Moderate | Open Treatment Of Rib Fracture(S) With Internal Fixation, Includes Thoracoscopic Visualization When Performed, Unilateral; 4-6 Ribs |
| 21813 | High | Open Treatment Of Rib Fracture(S) With Internal Fixation, Includes Thoracoscopic Visualization When Performed, Unilateral; 7 Or More Ribs |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21812. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21812 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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