CPT 21935 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21935 |
National average reimbursement for CPT 21935 by major payers:
$1,464.52
$1,424.46
$1,408.74
$1,724.33
| 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 21935 | ||||||
United | 21935 | $675.00 | 1689236242 - LEE MEMORIAL HEALTH SYSTEM, LEE HEALTH UROLOGY SURGERY CENTER | 843798404 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $1476.00 | 1245820042 - ALOE SURGICAL CENTER SCOTTSDALE, LLC | 845112576 - (AZ) ALOE SURGICAL CENTER SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $900.00 | 1740230523 - SARASOTA AMBULATORY SURGERY CENTER LTD, SARASOTA AMBULATORY SURGERY CENTER | 203686491 - (FL) SARASOTA AMBULATORY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $650.00 | 1326388000 - SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | 352467951 - (GA) SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $544.00 | 1497831523 - BOSTON IVF, INC., THE SURGERY CENTER OF WALTHAM | 42921956 - (MA) BOSTON IVF, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $1258.00 | 1477569069 - FISH POND SURGERY CENTER, LLC | 742901471 - (TX) FISH POND SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $2817.00 | 1366776106 - MEMORIAL HERMANN SURGERY CENTER RICHMOND, LLC, MEMORIAL HERMANN SURGERY CENTER RICHMOND | 270552583 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $1022.00 | 1114952686 - NORTH RICHLAND HILLS ENDOSCOPY CENTER LLC, DIGESTIVE HEALTH CENTER OF NORTH RICHLAND HILLS | 203711547 - (TX) NORTH RICHLAND HILLS ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $436.00 | 1811059306 - PENINSULA EYE CENTER, P.A, PENINSULA CATARACT & LASER CENTER | 520974706 - (MD) PENINSULA EYE CENTER PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $687.00 | 1508845942 - ENDOSCOPY CENTER OF KNOXVILLE LP, THE ENDOSCOPY CENTER WEST | 621512837 - (TN) ENDOSCOPY CENTER OF KNOXVILLE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $523.00 | 1316969058 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $508.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $1060.00 | 1194718312 - CAPE COD ASC LLC | 43424805 - (MA) CAPE COD ASSOC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $550.00 | 1245529189 - CAPITOL SURGICAL CENTER LLC | 275067646 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21935 | $800.00 | 1184819930 - EAST COBB PODIATRY SURGERY CENTER, LLC | 581486442 - (GA) EAST COBB PODIATRY SURGERY CENTER LLC | GA | 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 21935 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21935 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 21935 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 |
|---|---|---|
| 21933-CPT | High | Exc Tumor Soft Tiss Back Flank Subfascial 5 Cm |
| 21935-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Back Or Flank; Less Than 5 Cm (Revised 01/01/2014) |
| 21936-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Back Or Flank; 5 Cm Or Greater (Revised 01/01/2014) |
| 22010-CPT | High | Bx Spinal Sft Tissues;Superf-21920 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21935. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21935 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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