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See a sample rate comparisonCPT 21085 Fee Schedule
Medicare rates as of October 2026
CPT 21085 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | 11Office 22On Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | 51Multiple procedures 52Reduced Services |
| Hospital Outpatient Group (APC) | APC 5161 - Level 1 ENT Procedures |
| Surgery Center Payment (ASC) | P2 - Office-based; paid from the OPPS relative weight |
| Common Revenue Codes | 03600761Sign up to view all 3 |
| Medicare Fee Schedule | $710.10 national non-facility rate (2026)View Medicare rates for 21085 |
| Medicaid Fee Schedule | $551.89 median of the 8 states in the free previewView Medicaid rates for 21085 |
National average reimbursement for CPT 21085 by major payers:
$831.25
BCBS / Anthem
$960.45
UnitedHealthcare
$966.06
Aetna
$886.78
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21085.
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 table lists codes related to 21085. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21081-CPT | Impression And Custom Preparat, Impression And Custom Preparation Mandibular Resectionprosthesis Impression And Custom Preparation Mandibular Resection |
| 21084-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. |
| 21085-CPT | 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 | 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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Frequently Asked Questions
What APC is CPT 21085 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21085 to APC 5161 (Level 1 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21085 in an ambulatory surgery center?
CMS lists CPT 21085 with ASC payment indicator P2: Office-based; paid from the OPPS relative weight.
Which revenue codes are billed with CPT 21085?
Hospital price transparency files list CPT 21085 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.