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See a sample rate comparisonCPT 21049 Fee Schedule
Medicare rates as of October 2026
CPT 21049 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Excis Uppr Jaw Cyst W/Repair, Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Extra-Oral Osteotomy And Partial Maxillectomy (Eg Locally Aggressive Or Destructive Lesion[S])
| 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 | 59Distinct Procedural Service LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | G2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $1,021.07 national non-facility rate (2026)View Medicare rates for 21049 |
| Medicaid Fee Schedule | $826.83 median of the 8 states in the free previewView Medicaid rates for 21049 |
National average reimbursement for CPT 21049 by major payers:
$1,654.89
BCBS / Anthem
$1,633.07
UnitedHealthcare
$1,635.37
Aetna
$1,948.24
Cigna
Compare published rates across providers.
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CPT 21049
5 of 25 sample ratesHigher to lower in this preview
Surgcenter Of Orange Park, LLC, Orange Park Endoscopy Center
Surgcenter Of Orange Park LLC
$6,506.00Published rateLone Star Endoscopy Center LLC
$4,234.00Published rateAlfa Surgery Center, LLC
$2,908.00Published rateWest Norman Endoscopy Center, LLC
$1,700.00Published rateCampus Eye Group Asc Inc, Surgicenter Anesthesia Associates
$707.00Published rate
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See a sample payer proposalCPT 21049 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21049. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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]) |
| 21048-CPT | Remove Maxilla Cyst Complex, Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Intra-Oral Osteotomy (Eg Locally Aggressive Or Destructive Lesion[S]) |
| 21049-CPT | Excis Uppr Jaw Cyst W/Repair, Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Extra-Oral Osteotomy And Partial Maxillectomy (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 21049. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21049 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 21049 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21049 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 21049 in an ambulatory surgery center?
CMS lists CPT 21049 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21049?
Hospital price transparency files list CPT 21049 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.