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See a sample rate comparisonCPT 21936 Fee Schedule
Last Verified: October 2026
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.
Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Bck Or Flank, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Back Or Flank
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21936 |
| Medicaid Fee Schedule | View Medicaid rates for 21936 |
National average reimbursement for CPT 21936 by major payers:
$2,027.69
$1,951.54
$1,971.54
$2,321.89
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CPT 21936
5 of 25 sample ratesHigher to lower in this preview
Castle Hills Surgicare, LLC
Castle Hills Surgicare LLC
$4,141.00Published rateLoyola Ambulatory Surgery Center At Oakbrook Lp
$2,200.00Published rateKy Advanced Surgical Center Inc
$1,400.00Published rateDoctors Hospital Surgery Center, L.P.
Doctors Hospital Surgery Center Lp
$1,001.00Published ratePalmetto Endoscopy Center LLC
$534.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21936 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21936 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 21936 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 | Xcision Tumor Sft Tissue Of Bck Or Flank Subfasc (Eg Myomecto, Excision Tumor Soft Tissue Of Back Or Flank Subfascial (Eg Intramu |
| 21935-CPT | High | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Bck Or Flank, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Back Or Flank |
| 21936-CPT | High | Radical Resct Of Tumor (Eg Sarcom) Sft Tissue Of Bck Or Flank, Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Back Or Flank |
| 22010-CPT | High | I D P Spine C T Cerv Thor, Incision And Drainage Open Of Deep Abscess Subfascial Posterior Spine Cervical Thoracic Or Cervicothoracic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21936. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21936 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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