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See a sample rate comparisonCPT 21034 Fee Schedule
Medicare rates as of October 2026
CPT 21034 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Exc Malig Tumor Facial Bone
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 51Multiple procedures GCService performed by resident under supervision |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $1,305.64 national non-facility rate (2026)View Medicare rates for 21034 |
| Medicaid Fee Schedule | $1,057.965 median of the 8 states in the free previewView Medicaid rates for 21034 |
National average reimbursement for CPT 21034 by major payers:
$1,599.46
BCBS / Anthem
$1,739.99
UnitedHealthcare
$1,798.25
Aetna
$1,870.65
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21034.
CPT 21034
5 of 25 sample ratesHigher to lower in this preview
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC, Iu Health Surgery Center Fort Wayne
Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC
$11,291.00Published rateBoulevard Ent Surgery Center LLC
$4,184.00Published rateBarrington Surgical Care LLC, Barrington Surgical Care
Barrington Surgical Care LLC
$2,365.00Published rateRenue Surgery Center LLC
$1,547.00Published ratePremier Endoscopy Center LLC
$383.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21034 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21034. 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 21034. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21034 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 21034 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21034 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 21034 in an ambulatory surgery center?
CMS lists CPT 21034 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21034?
Hospital price transparency files list CPT 21034 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.