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See a sample rate comparisonCPT 21077 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.
Impression And Custom Preparation; Orbital Prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None SC - Medically necessary service or supply RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21077 |
| Medicaid Fee Schedule | View Medicaid rates for 21077 |
National average reimbursement for CPT 21077 by major payers:
$2,710.96
$3,139.41
$3,050.17
$3,155.31
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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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See a sample payer proposalCPT 21077 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21077 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 21077 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 |
| 21086-CPT | High | 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 | High | 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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