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See a sample rate comparisonCPT 21040 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.
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 | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21040 |
| Medicaid Fee Schedule | View Medicaid rates for 21040 |
National average reimbursement for CPT 21040 by major payers:
$615.04
$653.25
$669.04
$632.72
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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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See a sample payer proposalCPT 21040 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21040 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 21040 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 |
| 21026-CPT | Moderate | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Facial Bone, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Facial Bone( |
| 21031-CPT | Moderate | Exc Torus Mandibularis |
| 21040-CPT | Moderate | 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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