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See a sample rate comparisonCPT 21077 Fee Schedule
Medicare rates as of October 2026
CPT 21077 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Impression And Custom Preparation; Orbital Prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | SCMedically necessary service or supply RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $2,193.77 national non-facility rate (2026)View Medicare rates for 21077 |
| Medicaid Fee Schedule | $1,760.14 median of the 8 states in the free previewView Medicaid rates for 21077 |
National average reimbursement for CPT 21077 by major payers:
$2,710.96
BCBS / Anthem
$3,139.41
UnitedHealthcare
$3,050.17
Aetna
$3,155.31
Cigna
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Choose a payer to see a sample of rates for CPT 21077.
CPT 21077
5 of 25 sample ratesHigher to lower in this preview
Westminster Surgery Center
Westminster Surgery Center LLC
$6,506.00Published rateWesthealth Surgery Center LLC
$3,993.00Published rateSpecialty Surgical Center Of Thousand Oaks, L.P.
Specialty Surgical Center Of Thousand Oaks, Lp
$3,200.00Published ratePacific Surgical Institute Of Pain Management
$2,144.00Published rateSurgery Center Of Cullman LLC, Healthsouth/Woodlands Surgery Center Of Cullman, LLC
Surgery Center Of Cullman LLC
$1,355.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21077 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21077. 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 |
| 21086-CPT | Prepare Artificial Ear Contour, Creation Of A Prosthesis For The Ear From A Cast Model Of Impressions. It Is Used To Restore The Shape Of The Ear. |
| 21087-CPT | Prepare Nose Prosthesis, Creation Of A Prosthesis For The Nose From A Cast Model Of Impressions. It Is Used To Restore The Shape Of The Nose. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21077. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21077 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 21077 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21077 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 21077 in an ambulatory surgery center?
CMS lists CPT 21077 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21077?
Hospital price transparency files list CPT 21077 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.