CPT code 21725: Neck muscle revision, sternocleidomastoid muscle2026 Medicare rate & RVUs in Illinois
Revision of the sternocleidomastoid muscle is reported for operative correction of a persistent or recurrent neck-muscle problem after prior treatment.
CMS doesn’t publish an office rate for 21725 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 21725 covers
This code describes revision surgery on a neck muscle, typically the sternocleidomastoid, to address a persistent or recurrent deformity or functional problem. The surgeon works directly on the previously treated muscle; the service is distinct from an initial release or division. It is generally performed in an operating room by a surgeon treating a neck-muscle condition, such as residual or recurrent torticollis after earlier surgery.
Report the code when the operative record supports revision of the neck muscle itself, rather than a first-time release or a separate reconstruction of another structure. Documentation should identify the muscle, prior treatment, the reason revision is needed, and the work performed. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 21725 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $582.19 |
| East St. Louis, IL | Unavailable | $546.96 |
| Rest of Illinois | Unavailable | $523.04 |
| Suburban Chicago, IL | Unavailable | $561.44 |
How the 21725 rate is calculated
Each of 21725’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21725
RVUs × geographic indexes × conversion factor
Work7.01
7.01 RVUs× 1.000 GPCI
Practice expense6.94
6.94 RVUs× 1.000 GPCI
Malpractice1.48
1.48 RVUs× 1.000 GPCI
Adjusted RVUs
15.4300
Conversion factor
$33.4009
Medicare rate
$515.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21725
21725 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21725
Neck muscle revision, sternocleidomastoid muscle
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21725
Neck muscle revision, sternocleidomastoid muscle
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21725 without 51 · national facility
$515.38
Neck muscle revision, sternocleidomastoid muscle
21725-51 · Second procedure: 50%
$257.69
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21725 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21720Neck muscle repairSCM plastic operation
- Use 21720 for release of the sternocleidomastoid in congenital muscular torticollis. Use 21725 when the neck muscle is being revised after prior treatment.
- 21700Scalene divisionWithout cervical rib resection
- 21700 describes open division of the sternocleidomastoid for torticollis; 21725 represents revision work rather than the initial division.
- 21705Neck muscle surgeryMuscle resection
- 21705 is a torticollis division procedure extending into the thoracic area. It is not the revision service described by 21725.
21725 billing questions
How is 21725 distinguished from 21720?
21725 is for revision of a neck muscle after prior treatment. 21720 describes release of the sternocleidomastoid for congenital muscular torticollis, rather than revision surgery.
What documentation supports reporting 21725?
The operative report should identify the muscle, explain the persistent or recurrent problem and prior treatment, and describe the revision work performed.
Can modifier 50 be used for bilateral work?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How does the global period affect postoperative visits?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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