CPT 21925 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 • 22 - On Campus-Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
National average reimbursement for CPT 21925 by major payers:
$619.31
$604.17
$637.31
$781.39
| 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 21925 | ||||||
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CPT 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 |
|---|---|---|
| 21602 | High | Excision Of Chest Wall Tumor Involving Rib(S) With Plastic Reconstruction; Without Mediastinal Lymphadenectomy |
| 21920 | Moderate | Biopsy Back/Flank Superficial |
| 21925 | Moderate | Biopsy Back/Flank Deep |
| 21930 | Moderate | Removal (Less Than 3 Centimeters) Tissue Growth Beneath The Skin Of Back Or Flank |
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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