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See a sample rate comparisonCPT 21031 Fee Schedule
Medicare rates as of October 2026
CPT 21031 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Exc Torus Mandibularis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 50Bilateral Procedure RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5164 - Level 4 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $389.45 national non-facility rate (2026)View Medicare rates for 21031 |
| Medicaid Fee Schedule | $304.70 median of the 8 states in the free previewView Medicaid rates for 21031 |
National average reimbursement for CPT 21031 by major payers:
$477.90
BCBS / Anthem
$507.25
UnitedHealthcare
$520.82
Aetna
$473.99
Cigna
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CPT 21031
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Port Charlotte Ltd
$6,651.00Published rateLos Alamitos Surgery Center L P
$2,100.00Published rateVesc LLC, Adventhealth Surgery Center Ormond Beach
Vesc LLC
$1,847.00Published rateO'Fallon Surgical Center, LLC, Physicians Surgical Center
$1,377.00Published rateMarc Zabate
Deaconess Hospital Inc
$317.48Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21031 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21031. Select one to see its fee schedule.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21031. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21031 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 21031 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21031 to APC 5164 (Level 4 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21031 in an ambulatory surgery center?
CMS lists CPT 21031 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21031?
Hospital price transparency files list CPT 21031 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.