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See a sample rate comparisonCPT 21030 Fee Schedule
Medicare rates as of October 2026
CPT 21030 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 03600361Sign up to view all 3 |
| Medicare Fee Schedule | $475.96 national non-facility rate (2026)View Medicare rates for 21030 |
| Medicaid Fee Schedule | $379.09 median of the 8 states in the free previewView Medicaid rates for 21030 |
National average reimbursement for CPT 21030 by major payers:
$602.66
BCBS / Anthem
$653.66
UnitedHealthcare
$659.15
Aetna
$641.08
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21030.
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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Payer Contract Negotiation
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See a sample payer proposalCPT 21030 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21030. 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 |
| 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 |
| 21031-CPT | Exc Torus Mandibularis |
| 21032-CPT | 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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Frequently Asked Questions
What APC is CPT 21030 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21030 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 21030 in an ambulatory surgery center?
CMS lists CPT 21030 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21030?
Hospital price transparency files list CPT 21030 under these revenue codes: 0360, 0361 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.