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See a sample rate comparisonCPT 21046 Fee Schedule
Medicare rates as of October 2026
CPT 21046 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Remove Mandible Cyst Complex, Excision Of Benign Tumor Or Cyst Of Mandible; Requiring Intra-Oral Osteotomy (Eg Locally Aggressive Or Destructive Lesion[S])
| 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) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $899.49 national non-facility rate (2026)View Medicare rates for 21046 |
| Medicaid Fee Schedule | $730.865 median of the 8 states in the free previewView Medicaid rates for 21046 |
National average reimbursement for CPT 21046 by major payers:
$1,363.68
BCBS / Anthem
$1,425.07
UnitedHealthcare
$1,434.59
Aetna
$1,695.98
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21046.
CPT 21046
5 of 25 sample ratesHigher to lower in this preview
Texas Health Spine Surgery Center Alliance LLC
$8,238.00Published rateAdvanced Surgery Center Of Metairie LLC
Advanced Surgery Center Of Metairie
$5,354.00Published rateHamilton Ambulatory Surgery Center
Hamilton Ambulatory Surgery Center Inc
$4,253.00Published rateHuntsville Surgery Center LLC, Laser Eye Surgery Center
Huntsville Surgery Center LLC
$2,250.00Published rateMid- America Surgery Center, LLC
Mid America Surgery Center LLC
$1,200.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21046 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21046. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21044-CPT | Exc Malign Tumor Mandible |
| 21045-CPT | Exc Malig Tumor Mandible Rad Resect |
| 21046-CPT | Remove Mandible Cyst Complex, Excision Of Benign Tumor Or Cyst Of Mandible; Requiring Intra-Oral Osteotomy (Eg Locally Aggressive Or Destructive Lesion[S]) |
| 21047-CPT | Excise Lwr Jaw Cyst W/Repair, Excision Of Benign Tumor Or Cyst Of Mandible; Requiring Extra-Oral Osteotomy And Partial Mandibulectomy (Eg Locally Aggressive Or Destructive Lesion[S]) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21046. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21046 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 21046 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21046 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 21046 in an ambulatory surgery center?
CMS lists CPT 21046 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21046?
Hospital price transparency files list CPT 21046 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.