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See a sample rate comparisonCPT 21079 Fee Schedule
Medicare rates as of October 2026
CPT 21079 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Impression And Custom Preparat, Impression And Custom Preparation Interim Obturatorprosthesis Impression And Custom Preparation Interim Obturator
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 58Staged or related procedure during postoperative period 51Multiple procedures |
| Hospital Outpatient Group (APC) | APC 5164 - Level 4 ENT Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 03600761Sign up to view all 3 |
| Medicare Fee Schedule | $1,521.75 national non-facility rate (2026)View Medicare rates for 21079 |
| Medicaid Fee Schedule | $1,220.535 median of the 8 states in the free previewView Medicaid rates for 21079 |
National average reimbursement for CPT 21079 by major payers:
$1,831.91
BCBS / Anthem
$2,130.95
UnitedHealthcare
$2,088.58
Aetna
$2,119.37
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21079.
CPT 21079
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgery Center Of Cool Springs LLC, Vanderbilt Surgery Center Cool Springs
Ambulatory Surgery Center Of Cool Springs LLC
$9,039.00Published rateSurgcenter At Paradise Valley, LLC, Surgcenter At Pima Crossing
Surgcenter At Paradise Valley
$5,020.00Published rateCenter For Special Surgery LLC
$3,398.00Published rateIntegrated Surgical Institute, LLC
Integrated Surgical Institute
$1,957.00Published rateBay Area Endoscopy Center Limited Partnership
$360.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21079 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21079. 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. |
| 21079-CPT | Impression And Custom Preparat, Impression And Custom Preparation Interim Obturatorprosthesis Impression And Custom Preparation Interim Obturator |
| 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 21079. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21079 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 21079 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21079 to APC 5164 (Level 4 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21079 in an ambulatory surgery center?
CMS lists CPT 21079 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21079?
Hospital price transparency files list CPT 21079 under these revenue codes: 0360, 0761 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.