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See a sample rate comparisonCPT 21076 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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 | 11 - Office 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 58 - Staged or related procedure during postoperative period 51 - Multiple procedures XS - Separate Structure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21076 |
| Medicaid Fee Schedule | View Medicaid rates for 21076 |
National average reimbursement for CPT 21076 by major payers:
$1,081.38
$1,264.65
$1,240.96
$1,270.75
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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 CPT 21076 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 21076 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 |
|---|---|---|
| 21076-CPT | High | 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 | High | Impression And Custom Preparation; Orbital Prosthesis |
| 21080-CPT | High | 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 | High | 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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