CPT 21813 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 | • 21 - Inpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21813 |
National average reimbursement for CPT 21813 by major payers:
$1,352.60
$1,376.19
$1,355.84
$1,623.22
| 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 21813 | ||||||
United | 21813 | $1658.00 | 1154996361 - CHADDS FORD AMBULATORY SURGICAL CENTER, LLC | 831876495 - (PA) CHADDS FORD AMBULATORY SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1000.00 | 1396454963 - ST LUKES SURGICAL CENTER INC, ST. LUKE'S SURGICAL AT WESLEY CHAPEL | 592407224 - (FL) ST LUKES SURGICAL CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1490.00 | 1164007068 - SW HEALTH LP | 853293126 - (TX) SW HEALTH LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1412.00 | 1801844386 - SOUTHEASTERN UROLOGICAL PARTNERS LTD, SOUTHEASTERN SURGERY CENTER | 593470900 - (FL) SOUTHEASTERN UROLOGICAL PARTNERS, LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1450.00 | 1093449225 - NARROWS SURGERY CENTER PS | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $973.00 | 1831153527 - THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC. | 521532190 - (MD) THE SURGICAL CENTER OF GREATER ANNAPOLIS INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1168.00 | 1023057916 - PHYSICIANS DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1525.00 | 1740289024 - KOOTENAI OUTPATIENT SURGERY CNTR LLC, KOOTENAI OUTPATIENT SURGERY | 820523354 - (ID) KOOTENAI OUTPATIENT SURGERY | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $2388.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1117.00 | 1053510933 - MONTGOMERY EYE SURGERY CENTER LLC, MONTGOMERY EYE SURGERY CENTER | 621607284 - (AL) MONTGOMERY EYE SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $5177.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $2196.00 | 1366536880 - SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER, LLC | 911959910 - (WA) SOUTHWEST WASHINGTON REGIONAL SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1129.00 | 1841255775 - DUBUQUE ENDOSCOPY CENTER LC | 201597161 - (IA) DUBUQUE ENDOSCOPY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $1625.00 | 1770907172 - EYE AND LASER SURGERY CENTERS OF NEW JERSEY LLC | 462875016 - (NJ) EYE AND LASER SURGERY CENTERS OF NEW JERSEY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21813 | $865.00 | 1144382284 - PASADENA SURGERY CENTER LLC, PASADENA SURGERY CENTER | 203571435 - (FL) PASADENA SURGERY CENTER LLC | FL | 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 21813 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21813 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 21813 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-CPT | Moderate | Close Sternotomy Separation W/Wo Debride |
| 21811-CPT | Moderate | Once Per Dos Open Treatment Of Rib Fracture W/Internal Fixation, Includes Thoracoscopic Visualization When Performed; Unilateral 1-2 Ribs |
| 21812-CPT | Moderate | Open Treatment Of Rib Fracture(S) With Internal Fixation, Includes Thoracoscopic Visualization When Performed, Unilateral; 4-6 Ribs |
| 21813-CPT | 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 21813. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21813 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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