CPT 22101 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22101 |
National average reimbursement for CPT 22101 by major payers:
$1,105.11
$1,151.58
$1,233.33
$1,437.08
| 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 22101 | ||||||
United | 22101 | $2446.00 | 1508869645 - FRESNO CA ENDOSCOPY ASC, LP, CENTRAL CALIFORNIA ENDOSCOPY CENTER | 912127626 - (CA) FRESNO CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $6588.00 | 1841626090 - COLUMBUS ENDOSCOPY CENTER LLC | 463368948 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $1400.00 | 1619284536 - CHILDRENS SURGERY CENTER, LLC | 273074039 - (PA) CHILDRENS SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $1067.00 | 1871591248 - NOVAMED SURGERY CENTER OF NASHUA, LLC, NASHUA EYE SURGERY CENTER | 770618679 - (NH) NOVAMED SURGERY CENTER OF NASHUA LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $7350.00 | 1275071789 - KADLEC REGIONAL MEDICAL CENTER | 910655392 - KADLEC REGIONAL MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $4000.00 | 1982206728 - FIRST CHOICE AMBULATORY SURGICAL CENTER LLC, LEGENT ASC MED CENTER | 852384947 - (TX) FIRST CHOICE AMBULATORY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $2400.00 | 1093786501 - SURGERY CENTER OF EASTON LP, HEALTHSOUTH SURGERY CENTER OF EASTON, L.P. | 721349755 - (MD) SURGERY CENTER OF EASTON LP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $5389.00 | 1821528753 - KENNEDY CHERRY HILL SURGICAL CENTER LLC, JEFFERSON SURGERY CENTER - CHERRY HILL | 472462625 - (NJ) KENNEDY CHERRY HILL SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $1769.00 | 1669481255 - SURGERY CENTER OF CULLMAN LLC, HEALTHSOUTH/WOODLANDS SURGERY CENTER OF CULLMAN, LLC | 203489003 - (AL) SURGERY CENTER OF CULLMAN LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $3145.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $7888.00 | 1225375587 - GCSA AMBULATORY SURGERY CENTER, LLC, GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO - STONE OAK | 611699459 - (TX) GCSA AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $6492.00 | 1275292229 - SCOTTSDALE ENDOSCOPY ASC LLC | 873952617 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $6492.00 | 1750363461 - BARKLEY SURGICENTER, LLC | 650428622 - (FL) BARKLEY SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $6365.00 | 1902959190 - RIVA ROAD SURGICAL CENTER, LLC | 870774597 - (MD) RIVA ROAD SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22101 | $3772.00 | 1063164960 - ADVANCED SURGICAL CARE OF VIERA, LLC | 872178964 - (FL) ADVANCED SURGICAL CARE OF VIERA LLC | FL | 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 22101 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22101 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 22101 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 |
|---|---|---|
| 22100-CPT | High | Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lamina Or Facet) For Intrinsic Bony Lesion, Single Vertebral Segment; Cervical |
| 22101-CPT | High | Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lamina Or Facet) For Intrinsic Bony Lesion, Single Vertebral Segment; Thoracic |
| 22102-CPT | Moderate | Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lamina Or Facet) For Intrinsic Bony Lesion, Single Vertebral Segment; Lumbar |
| 22103-CPT | Low | Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lamina Or Facet) For Intrinsic Bony Lesion, Single Vertebral Segment; Each Additional Segment (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22101. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22101 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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