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See a sample rate comparisonCPT 21085 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Prepare Mouth Prosthesis, Creation Of A Prosthesis For The Mouth From A Cast Model Of Impressions. It Is Used In Jaw Surgery And Repair Of Facial Injuries.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 52 - Reduced Services |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21085 |
| Medicaid Fee Schedule | View Medicaid rates for 21085 |
National average reimbursement for CPT 21085 by major payers:
$831.25
$960.45
$966.06
$886.78
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CPT 21085
5 of 25 sample ratesHigher to lower in this preview
Dallas Surgical Partners, LLC, Baylor Scott & White Surgicare
Dallas Surgical Partners LLC
$1,301.00Published rateAlabama Digestive Health Endoscopy Center, LLC
Alabama Digestive Health
$574.00Published rateKadlec Regional Medical Center, Kadlec Ambulatory Endoscopy Center, Lee Campus
Kadlec Regional Medical Center
$350.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$186.00Published rateSan Diego Eyecor LLC
San Diego Eye Cor., Inc.
$96.00Published rate
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See a sample payer proposalCPT 21085 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21085 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 21085 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 |
|---|---|---|
| 21081-CPT | High | Impression And Custom Preparat, Impression And Custom Preparation Mandibular Resectionprosthesis Impression And Custom Preparation Mandibular Resection |
| 21084-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. |
| 21085-CPT | Moderate | Prepare Mouth Prosthesis, Creation Of A Prosthesis For The Mouth From A Cast Model Of Impressions. It Is Used In Jaw Surgery And Repair Of Facial Injuries. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21085. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21085 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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