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See a sample rate comparisonCPT 21080 Fee Schedule
Medicare rates as of October 2026
CPT 21080 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 |
| 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 | 03600361 |
| Medicare Fee Schedule | $1,729.83 national non-facility rate (2026)View Medicare rates for 21080 |
| Medicaid Fee Schedule | $1,387.02 median of the 8 states in the free previewView Medicaid rates for 21080 |
National average reimbursement for CPT 21080 by major payers:
$2,180.01
BCBS / Anthem
$2,422.72
UnitedHealthcare
$2,393.64
Aetna
$2,393.01
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21080.
CPT 21080
5 of 25 sample ratesHigher to lower in this preview
Eagle Highlands Surgery Center LLC, Eagle Highlands Surgery Center
$11,291.00Published rateNorth Suburban Pain And Spine Center LLC
North Suburban Pain & Spine Cent
$4,108.00Published rateClearway Surgery Center Of Crestview, LLC
Clearway Surgery Center Of Crestview LLC
$2,858.00Published rateNew Jersey Interventional Associates LLC
$2,200.00Published rateGlen Endoscopy Center, LLC
The Glen Endoscopy Center, LLC
$816.00Published rate
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See a sample payer proposalCPT 21080 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21080. 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 21080. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21080 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 21080 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21080 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 21080 in an ambulatory surgery center?
CMS lists CPT 21080 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21080?
Hospital price transparency files list CPT 21080 under these revenue codes: 0360 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.