CPT 21936 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 • 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 |
National average reimbursement for CPT 21936 by major payers:
$2,027.69
$1,951.54
$1,971.54
$2,377.48
| 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 21936 | ||||||
United | 21936 | $2206.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $4141.00 | 1134663677 - CASTLE HILLS SURGICARE, LLC | 813020487 - (TX) CASTLE HILLS SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1884.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $2200.00 | 1407812498 - LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | 364119522 - (IL) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1191.00 | 1831238773 - CORPUS CHRISTI ENDOSCOPY CENTER LLP, CORPUS CHRISTI ENDOSCOPY CENTER | 202595593 - (TX) CORPUS CHRISTI ENDOSCOPY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $3245.00 | 1316449168 - SURGERY CENTER AT ST. VINCENT, LLC, EAST PAVILION SURGERY CENTER | 813129674 - (OR) SURGERY CENTER AT ST VINCENT LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1700.00 | 1063422962 - SAN ANTONIO AMBULATORY SURGICAL CENTER, LLC | 330857893 - (CA) SAN ANTONIO AMBULATORY SURGICAL CTR TER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $3681.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $2388.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1345.00 | 1518579903 - AMIN SURGERY CENTER FOR WOMEN LLC | 843102358 - (GA) AMIN SURGERY CENTER FOR WOMEN LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $575.00 | 1023015989 - TUCSON GASTROENTEROLOGY INSTITUTE, LLC | 860966257 - (AZ) TUCSON GASTROENTEROLOGY INSTITUTE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1400.00 | 1730514027 - KY ADVANCED SURGICAL CENTER INC | 901005366 - (CA) KY ADVANCED SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $534.00 | 1376592204 - PALMETTO ENDOSCOPY CENTER LLC | 571195554 - (SC) PALMETTO ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1000.00 | 1114035946 - LAFAYETTE GENERAL ENDOSCOPY CENTER, INC., THE ENDOSCOPY CENTER | 721121943 - (LA) LAFAYETTE GENERAL ENDOSCOPY CENTER, INC. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21936 | $1001.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | 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 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 | 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 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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