Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 21026 Fee Schedule
Medicare rates as of October 2026
CPT 21026 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Facial Bone, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Facial Bone(
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 24Ambulatory Surgical Center |
| 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 | $576.17 national non-facility rate (2026)View Medicare rates for 21026 |
| Medicaid Fee Schedule | $458.38 median of the 8 states in the free previewView Medicaid rates for 21026 |
National average reimbursement for CPT 21026 by major payers:
$677.99
BCBS / Anthem
$758.57
UnitedHealthcare
$767.92
Aetna
$903.74
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21026.
CPT 21026
5 of 25 sample ratesHigher to lower in this preview
Pinnacle Surgery Center, Inc
Pinnacle Surgery Center Inc
$8,000.00Published rateDestin Surgery Center LLC
$2,206.00Published rateSeattle Pain Relief PLLC, Federal Way Ambulatory Surgical Facility
Seattle Pain Relief PLLC
$1,525.00Published rateValley Outpatient Surgical Center Inc
$1,091.00Published rateUnion City Asc LLC, Summit Endoscopy Center
$800.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Looking for other data?
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 21026 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21026. 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 |
| 21040-CPT | Excision Of Benign Cyst Or Tum, Excision Of Benign Cyst Or Tumor Of Mandible Simpleexcision Of Benign Cyst Or Tumor Of Mandible Simple |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21026 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21026) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
What APC is CPT 21026 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21026 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 21026 in an ambulatory surgery center?
CMS lists CPT 21026 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which add-on codes are billed with CPT 21026?
CMS add-on code edits list CPT 21026 as a primary code for these add-on codes: 20700.
Which revenue codes are billed with CPT 21026?
Hospital price transparency files list CPT 21026 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.