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See a sample rate comparisonCPT 21030 Fee Schedule
Last Verified: September 2026
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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21030 |
| Medicaid Fee Schedule | View Medicaid rates for 21030 |
National average reimbursement for CPT 21030 by major payers:
$602.66
$653.66
$659.15
$641.08
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CPT 21030
5 of 25 sample ratesHigher to lower in this preview
Glastonbury Surgery Center, LLC
$4,617.00Published rateEndo Surgi Center Of Old Bridge LLC
Endo-Surgi Center Of Old Bridge, LLC
$1,870.00Published rateOverlake Reproductive Health Inc Ps., Overlake Reproductive Health Inc.- Ambulatory Surgical Facility
Overlake Reproductive Health, Inc., P.S.
$1,500.00Published rateSt George Surgical Center Lp
St. George Surgical Center
$1,023.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$691.00Published rate
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See a sample payer proposalCPT 21030 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21030 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 21030 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.
| Code | Complexity | Description |
|---|---|---|
| 21025-CPT | High | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Mandibl, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Mandible |
| 21030-CPT | Moderate | 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 |
| 21031-CPT | Moderate | Exc Torus Mandibularis |
| 21032-CPT | Moderate | Excision Maxillary Torus Palatinus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21030. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21030 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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