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See a sample rate comparisonCPT 21086 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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 | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 50 - Bilateral Procedure RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21086 |
| Medicaid Fee Schedule | View Medicaid rates for 21086 |
National average reimbursement for CPT 21086 by major payers:
$2,089.34
$2,330.92
$2,355.50
$2,327.00
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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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See a sample payer proposalCPT 21086 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21086 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 21086 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 |
|---|---|---|
| 21077-CPT | High | Impression And Custom Preparation; Orbital Prosthesis |
| 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. |
| 21087-CPT | High | 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 | High | 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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