CPT 69421 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Auditory System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 69421 |
National average reimbursement for CPT 69421 by major payers:

$210.45

$193.95

$211.35

$253.54
| 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 69421 | ||||||
United | 69421 | $1233.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $1275.00 | 1619166097 - GPDDC, LLC | 43769350 - (NY) GPDDC, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $775.00 | 1881850121 - NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER, LLC | 260211984 - (GA) NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $258.82 | 1114159514 - BILAL HIJAZI | 350593390 - DEACONESS HOSPITAL INC | TN | Emergency Medicine Physician (207P00000X) |
United | 69421 | $1123.00 | 1972869881 - ADVANCED SURGERY CENTER OF BETHESDA, LLC | 454376136 - (MD) ASC BETHESDA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $420.00 | 1033250618 - MCDOWELL AMBULATORY SURGERY CENTER LLC | 261184708 - (AZ) MCDOWELL AMBULATORY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $944.00 | 1881738607 - NACOGDOCHES COUNTY HOSPITAL DISTRICT, NACOGDOCHES MEMORIAL HOSPITAL DAY SURG CIDC | 871142127 - (TX) LION STAR NACOGDOCHES HOSPITAL, LLC DBA NACOGDOCHES MEMORIAL HOSPITAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $883.00 | 1215990627 - WESTSIDE SURGERY CENTER LLC, WESTSIDE SURGERY CENTER LTD | 593026856 - (FL) WESTSIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $1528.00 | 1679504690 - SANTA CLARITA SURGERY CENTER LP | 202829660 - (CA) SANTA CLARITA SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $425.00 | 1962869446 - FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC | 473997859 - (NC) FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $714.00 | 1972055382 - ALLIANCE SURGERY PARTNERS, LLC | 901108673 - (CA) ALLIANCE SURGERY PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $347.00 | 1609039056 - FARSHID PAYDAR MD PC, THE EYE CLINIC | 454779006 - (AZ) FARSHID PAYDAR MD PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $471.00 | 1588665269 - RF EYE PC, COCHISE EYE & LASER ASC | 860879991 - (AZ) R.F. EYE, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 69421 | $258.82 | 1982818571 - RICHARD JOSEPH | 350593390 - DEACONESS HOSPITAL INC | IL | Emergency Medicine Physician (207P00000X) |
United | 69421 | $560.00 | 1417287137 - EAST PORTLAND SURGERY CENTER LLC | 271402985 - (OR) EAST PORTLAND SURGERY CENTER, LLC | OR | 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 69421 vs. Other Surgical Procedures on the Auditory System Codes
The CPT 69421 code is part of the Surgery services used for Surgical Procedures on the Auditory 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 69421 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 69421. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 69421 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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