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See a sample rate comparisonCPT 21025 Fee Schedule
Medicare rates as of October 2026
CPT 21025 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Mandibl, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Mandible
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 59Distinct Procedural Service 58Staged or related procedure during postoperative period |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Add-on Codes | 20700 |
| Common Revenue Codes | 03600761 |
| Medicare Fee Schedule | $840.03 national non-facility rate (2026)View Medicare rates for 21025 |
| Medicaid Fee Schedule | $679.22 median of the 8 states in the free previewView Medicaid rates for 21025 |
National average reimbursement for CPT 21025 by major payers:
$1,069.77
BCBS / Anthem
$1,140.52
UnitedHealthcare
$1,157.02
Aetna
$1,157.65
Cigna
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CPT 21025
5 of 25 sample ratesHigher to lower in this preview
Manatee Surgicare Ltd
$7,391.00Published rateClearway Surgery Center Of Prince Frederick LLC
$3,405.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$2,693.00Published rateLee Memorial Health System, Lee Health Urology Surgery Center
$2,050.00Published rateSouth Carolina Endoscopy Center
$700.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21025 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21025. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21025-CPT | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Mandibl, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Mandible |
| 21026-CPT | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Facial Bone, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Facial Bone( |
| 21029-CPT | Remval By Contour Of Bnign Tumor Of Facial Bone (Eg Fibrous Dysp, Removal By Contouring Of Benign Tumor Of Facial Bone (Eg Fibrous Dysp |
| 21030-CPT | Xcision Of Bnign Tumor Or Cyst Of Maxilla Or Zygoma By Enucleati, Excision Of Benign Tumor Or Cyst Of Maxilla Or Zygoma By Enucleation A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21025. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21025 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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Frequently Asked Questions
What APC is CPT 21025 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21025 to APC 5165 (Level 5 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21025 in an ambulatory surgery center?
CMS lists CPT 21025 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which add-on codes are billed with CPT 21025?
CMS add-on code edits list CPT 21025 as a primary code for these add-on codes: 20700.
Which revenue codes are billed with CPT 21025?
Hospital price transparency files list CPT 21025 under these revenue codes: 0360 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.