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See a sample rate comparisonCPT 21088 Fee Schedule
CPT 21088 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Impression And Custom Preparat, Impression And Custom Preparation Facial Prosthesisimpression And Custom Preparation Facial Prosthesis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 22On Campus Outpatient Hospital 19Off Campus Outpatient Hospital 21Inpatient Hospital |
| Common Modifiers | 78Return to OR - related procedure |
| Hospital Outpatient Group (APC) | APC 5164 - Level 4 ENT Procedures |
| Surgery Center Payment (ASC) | R2 - Office-based; paid from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | View Medicare rates for 21088 |
| Medicaid Fee Schedule | $1,796.815 median of the 6 states in the free previewView Medicaid rates for 21088 |
National average reimbursement for CPT 21088 by major payers:
$3,619.41
BCBS / Anthem
$3,680.66
UnitedHealthcare
$3,287.61
Aetna
$3,804.01
Cigna
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Choose a payer to see a sample of rates for CPT 21088.
CPT 21088
5 of 25 sample ratesHigher to lower in this preview
Belleair Surgery Center Ltd
$7,391.00Published rateEndoscopy Of Plano, Lp, Gastrointestinal Endoscopy Center Of Plano
Endoscopy Of Plano Lp
$4,676.00Published ratePend Oreille Surgery Center LLC
$3,003.00Published rateWomen'S Surgical Center
Womens Surgical Center
$2,500.00Published rateSkin & Mohs Surgery Center, LLC
Skin Mohs Surgery Center LLC
$843.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21088 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21088. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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. |
| 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 21088. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21088 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 21088 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21088 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 21088 in an ambulatory surgery center?
CMS lists CPT 21088 with ASC payment indicator R2: Office-based; paid from the OPPS relative weight.
Which revenue codes are billed with CPT 21088?
Hospital price transparency files list CPT 21088 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.