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See a sample rate comparisonCPT 21076 Fee Schedule
Medicare rates as of October 2026
CPT 21076 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | 58Staged or related procedure during postoperative period 51Multiple procedures XSSeparate Structure |
| Hospital Outpatient Group (APC) | APC 5163 - Level 3 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $919.86 national non-facility rate (2026)View Medicare rates for 21076 |
| Medicaid Fee Schedule | $736.35 median of the 8 states in the free previewView Medicaid rates for 21076 |
National average reimbursement for CPT 21076 by major payers:
$1,081.38
BCBS / Anthem
$1,264.65
UnitedHealthcare
$1,240.96
Aetna
$1,270.75
Cigna
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CPT 21076
5 of 25 sample ratesHigher to lower in this preview
Surgery Center Of Southwest Ohio, LLC, The Surgery Center Of Southwest Ohio
The Surgery Center Of Southwest
$5,660.00Published rateDoylestown Surgery Center, LLC
Doylestown Surgery Center LLC
$969.00Published rateCleveland Asc LLC, Cleveland Surgical Suites
Cleveland Asc LLC
$700.00Published ratePhoenix Ophthalmology Asc LLC, Arizona Ophthalmic Outpatient Surgery
Phoenix Ophthalmology Asc LLC
$600.00Published rateAlabama Eye Surgery Center LLC
$399.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21076 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21076. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21076-CPT | Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech. |
| 21077-CPT | Impression And Custom Preparation; Orbital Prosthesis |
| 21080-CPT | Custom Artificial Palate, A Prosthesis Made For The Roof Of The Mouth (Palate) From A Cast Model Of Impressions. It Is Used To Restore Oral Functions Such As Chewing Swallowing And Speech. |
| 21081-CPT | Impression And Custom Preparat, Impression And Custom Preparation Mandibular Resectionprosthesis Impression And Custom Preparation Mandibular Resection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21076. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21076 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 21076 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21076 to APC 5163 (Level 3 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21076 in an ambulatory surgery center?
CMS lists CPT 21076 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21076?
Hospital price transparency files list CPT 21076 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.