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See a sample rate comparisonCPT 21086 Fee Schedule
Medicare rates as of October 2026
CPT 21086 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 50Bilateral Procedure RTRight side of body |
| 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 | $1,627.29 national non-facility rate (2026)View Medicare rates for 21086 |
| Medicaid Fee Schedule | $1,291.015 median of the 8 states in the free previewView Medicaid rates for 21086 |
National average reimbursement for CPT 21086 by major payers:
$2,089.34
BCBS / Anthem
$2,330.92
UnitedHealthcare
$2,355.50
Aetna
$2,327.00
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21086.
CPT 21086
5 of 25 sample ratesHigher to lower in this preview
Oil Center Surgical Plaza
$5,592.00Published rateWinter Park Surgery Center Lp, Physician'S Surgical Care Center
Winter Park Surgery Center Lp
$3,275.00Published rateCapital Surgery And Laser Center, LLC
Capital Surgery And Laser Center LLC
$1,753.00Published rateArrowhead Surgery Center LLC
$1,320.00Published rateFox Eye Surgery, LLC, First Choice Surgery Center
Fox Eye Surgery LLC
$963.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21086 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21086. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21077-CPT | Impression And Custom Preparation; Orbital Prosthesis |
| 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. |
| 21087-CPT | Prepare Nose Prosthesis, Creation Of A Prosthesis For The Nose From A Cast Model Of Impressions. It Is Used To Restore The Shape Of The Nose. |
| 21088-CPT | Impression And Custom Preparat, Impression And Custom Preparation Facial Prosthesisimpression And Custom Preparation Facial Prosthesis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21086. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21086 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 21086 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21086 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 21086 in an ambulatory surgery center?
CMS lists CPT 21086 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 21086?
Hospital price transparency files list CPT 21086 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.