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See a sample rate comparisonCPT 41251 Fee Schedule
Last Verified: October 2026
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.
Rpair Of Lacerat 2.5 Cm Or <; Posteri One-Third Of Tongue, Repair Of Laceration 2.5 Cm Or Less; Posterior One-Third Of Tongue
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | AG - Primary physician 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $427.87 national non-facility rate (2026) · View Medicare rates for 41251 |
| Medicaid Fee Schedule | $301.58 median of the 8 states in the free preview · View Medicaid rates for 41251 |
National average reimbursement for CPT 41251 by major payers:
$336.99
$377.04
$410.05
$493.47
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CPT 41251
5 of 25 sample ratesHigher to lower in this preview
Indianapolis Endoscopy Center LLP
$3,922.00Published rateSaint Francis Surgery Center, LLC, Saint Francis Surgery Center
Saint Francis Surgery Center LLC
$666.00Published rateGastrointestinal Institute, LLC.
Gastrointestinal Institute LLC
$500.00Published rateOrange County Digestive Center, Inc
Orange County Digestive Center, Inc.
$126.00Published rateGeorgia Neurosurgical Institute Outpatient Surgery Center, Georgia Neurosurgical Institute Outpatient Surgery Center
Georgia Neurosurgical Institute Outpatient Surgery Center
$64.00Published rate
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See a sample payer proposalCPT 41251 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 41251 code is part of the Surgery services used for Surgical Procedures on the Digestive 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 41251 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 |
|---|---|---|
| 41116-CPT | Moderate | Exc Lesion Oral Floor |
| 41250-CPT | Moderate | Repair Of Laceration 2.5 Cm O, Repair Of Laceration 2.5 Cm Or Less Floor Of Mouth Andor Anterior Two-Thirds Of Tongue Repair Of Laceration 2.5 Cm Or Less Floor Of Mouth Andor |
| 41251-CPT | Moderate | Rpair Of Lacerat 2.5 Cm Or <; Posteri One-Third Of Tongue, Repair Of Laceration 2.5 Cm Or Less; Posterior One-Third Of Tongue |
| 41252-CPT | Moderate | Repair Of Laceration Of Tongu, Repair Of Laceration Of Tongue Floor Of Mouth Over 2.6 Cmor Complex Repair Of Laceration Of Tongue Floor Of Mouth Over 2.6 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 41251. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 41251 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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