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See a sample rate comparisonCPT 21925 Fee Schedule
Last Verified: October 2026
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.
Biopsy Back/Flank Deep
| 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 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21925 |
| Medicaid Fee Schedule | View Medicaid rates for 21925 |
National average reimbursement for CPT 21925 by major payers:
$619.31
$604.17
$637.31
$606.65
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CPT 21925
5 of 25 sample ratesHigher to lower in this preview
Physicians West El Paso Surgery Center, LLC
$6,259.00Published rateMinimally Invasive Surgery Center Of N.E., LLC
$2,859.00Published ratePolaris Center For Outpatient Spine Surgery
$1,600.00Published rateCypress Ambulatory Surgery Center
Cypress Ambulatory Surgery Cen
$1,350.00Published rateLaser Surgery Holding Company, Ltd
Laser Surgery Holding Company Lt
$454.00Published rate
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See a sample payer proposalCPT 21925 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21925 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 21925 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 |
|---|---|---|
| 21920-CPT | Moderate | Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy). |
| 21925-CPT | Moderate | Biopsy Back/Flank Deep |
| 21930-CPT | Moderate | Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane Less Than, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; Less Than |
| 21931-CPT | Moderate | Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane 3 Cm Or G, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; 3 Cm Or G |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21925. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21925 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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