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See a sample rate comparisonCPT 21040 Fee Schedule
Medicare rates as of October 2026
CPT 21040 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Excision Of Benign Cyst Or Tum, Excision Of Benign Cyst Or Tumor Of Mandible Simpleexcision Of Benign Cyst Or Tumor Of Mandible Simple
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 59Distinct Procedural Service RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5164 - Level 4 ENT Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600361Sign up to view all 3 |
| Medicare Fee Schedule | $479.97 national non-facility rate (2026)View Medicare rates for 21040 |
| Medicaid Fee Schedule | $381.42 median of the 8 states in the free previewView Medicaid rates for 21040 |
National average reimbursement for CPT 21040 by major payers:
$615.04
BCBS / Anthem
$653.25
UnitedHealthcare
$669.04
Aetna
$632.72
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21040.
CPT 21040
5 of 25 sample ratesHigher to lower in this preview
Emory Ambulatory Surgery Center At Dunwoody, LLC
Emory Ambulatory Surgery Center At Dunwoody LLC
$4,041.00Published rateMason Ridge Ambulatory Surgery Center Lp, Gateway Endoscopy Center
$2,206.00Published rateSaint Charles Surgical Pavilion Inc
$1,226.00Published rateSurgery Center Of Zachary, LLC
$1,023.00Published rateLocust Grove Endo Center
$390.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21040 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21040. 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( |
| 21031-CPT | Exc Torus Mandibularis |
| 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 21040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21040 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 21040 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21040 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 21040 in an ambulatory surgery center?
CMS lists CPT 21040 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21040?
Hospital price transparency files list CPT 21040 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.