CPT 21820 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 | • 23 - Emergency Room • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • 54 - Surgical Care Only • AG - Primary physician |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 21820 |
National average reimbursement for CPT 21820 by major payers:
$183.62
$189.80
$200.34
$248.03
| 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 21820 | ||||||
United | 21820 | $906.00 | 1902204654 - DENVER SURGICENTER, LLC | 472340660 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $51.00 | 1679566228 - AMBULATORY FOOT AND ANKLE CENTER, INC. | 521910756 - (MD) AMBULATORY FOOT AND ANKLE CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $87.00 | 1982978466 - NORTHWEST ENT SURGERY CENTER, LLC | 453307193 - (GA) NORTHWEST ENT SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $106.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $120.00 | 1316924632 - CAROLINA BONE & JOINT SURGERY CENTER | 134241163 - (SC) CAROLINA BONE & JOINT SURGERY | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $500.00 | 1508934373 - CENTERS FOR PAIN SOLUTIONS,LLC | 20522938 - (NH) CENTERS FOR PAIN SOLUTIONSLLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $566.00 | 1427003052 - EYE SURGERY CENTER OF NASHVILLE LLC | 621872622 - (TN) EYE SURGERY CENTER OF NASHVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $410.00 | 1972578771 - SUN CITY AZ ENDOSCOPY ASC LLC, SUN CITY ENDOSCOPY CENTER | 201519369 - (AZ) SUN CITY AZ ENDOSCOPY ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $244.00 | 1629320742 - DENVER WEST ENDOSCOPY CENTER, LLC | 460788218 - (CO) DENVER WEST ENDOSCOPY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $574.00 | 1275198673 - UROLOGY ASC- PHOENIX, LLC, UROLOGIC SURGERY CENTER OF ARIZONA | 320586987 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $506.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $532.00 | 1568583896 - EASTERN ORANGE AMBULATORY SURGERY CENTER, LLC | 205350007 - (NY) EASTERN ORANGE ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $566.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $351.00 | 1326549676 - CHATHAM ORTHOPAEDIC ASC, LLC, CHATHAM ORTHOPAEDIC SURGERY CENTER | 824075002 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21820 | $83.00 | 1295906956 - THE ENT CENTER OF RHODE ISLAND LLC, THE SURGERY CENTER OF RHODE ISLAND | 260329297 - (RI) THE ENT CENTER OF RHODE ISLAND | RI | 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 21820 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21820 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 21820 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 |
| 21820-CPT | Low | Red Fx-Sternum Closed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21820 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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