21401
Closed tx orbit w/manipulj
Code typePrimary
Payment statusActive (A)
Global period90-day
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary21401Closed tx orbit w/manipulj
1
$552.12
$315.64
RVU Breakdown
Component
Office
Facility
Work
3.59
3.59
Practice expense
12.28
5.20
Malpractice
0.66
0.66
Total RVU
16.53
9.45
Payment Policy & Modifiers
Allowed adjustments
Bilateral -50150%
With modifier 50 (both sides), payment is 150% of the single-side amount. → $828.18 office.
Multiple procedure MPPRApplies
When billed with other procedures the same day: highest-valued paid 100%, the rest 50%.
Assistant surgeon -80/81/8216%
Assistant at surgery (mod 80/81/82) is paid at 16% of the fee schedule amount.
Not applicable to this code
Co-surgeon -62Team surgeon -66Prof / tech split