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See a sample rate comparisonCPT 21081 Fee Schedule
Medicare rates as of October 2026
CPT 21081 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Impression And Custom Preparat, Impression And Custom Preparation Mandibular Resectionprosthesis Impression And Custom Preparation Mandibular Resection
| 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 59Distinct Procedural Service |
| 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 | $1,592.22 national non-facility rate (2026)View Medicare rates for 21081 |
| Medicaid Fee Schedule | $1,276.46 median of the 8 states in the free previewView Medicaid rates for 21081 |
National average reimbursement for CPT 21081 by major payers:
$2,052.26
BCBS / Anthem
$2,222.94
UnitedHealthcare
$2,171.65
Aetna
$2,189.91
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21081.
CPT 21081
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, Emory Clinic Ambulatory Surgery Center
Emory University
$7,635.00Published rateGlenwood Surgical Center L P
Glenwood Surgical Center Lp
$4,141.00Published rateRwmc Ambulatory Surgery Center, LLC, Scottsbluff Surgery Center
Rwmc Ambulatory Surgery Center LLC
$2,650.00Published rateRebecca Schadler
Deaconess Hospital Inc
$1,359.06Published rateBarnet Dulaney Perkins Eye Center, PC, American Vision Partners
Barnet Dulaney Perkins Eye Center PLLC
$713.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21081 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21081. 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 21081. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21081 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 21081 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21081 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 21081 in an ambulatory surgery center?
CMS lists CPT 21081 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21081?
Hospital price transparency files list CPT 21081 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.