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See a sample rate comparisonCPT 21125 Fee Schedule
Last Verified: October 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.
Augmentation Mandibular Body, Augmentation Mandibular Body Or Angle Prostheticmaterial Augmentation Mandibular Body Or Angle Prosthetic Material
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center 21 - Inpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21125 |
| Medicaid Fee Schedule | View Medicaid rates for 21125 |
National average reimbursement for CPT 21125 by major payers:
$3,072.43
$3,726.69
$3,675.29
$4,403.21
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CPT 21125
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Memorial City LLC, Memorial Hermann Memorial Village Surgery Center
$5,729.00Published rateSummit Ambulatory Surgical Center, LLC
$2,388.00Published ratePersepolis Group LLC
$1,700.00Published rateMission Valley Hegihts Surgery Center, Mission Valley Outpatient Surgery Center
Poway Ca Multi-Specialty Asc LLC
$1,300.00Published rateNorth River Surgery Center, LLC
North River Surgery Center LLC
$650.00Published rate
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See a sample payer proposalCPT 21125 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21125 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 21125 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 |
|---|---|---|
| 21120-CPT | Moderate | Genioplasty Augmentation (Aut, Genioplasty Augmentation (Autograft Allograft Prosthetic Material) Genioplasty Augmentation (Autograft Allograft Prosthetic |
| 21123-CPT | High | Genioplasty Sliding Augmenta, Genioplasty Sliding Augmentation With Interpositional Bonegrafts (Includes Obtaining Autografts) Genioplasty Sliding Augmentation With Interpositional Bone |
| 21125-CPT | High | Augmentation Mandibular Body, Augmentation Mandibular Body Or Angle Prostheticmaterial Augmentation Mandibular Body Or Angle Prosthetic Material |
| 21127-CPT | High | Augmentation Mandibular Body, Augmentation Mandibular Body Or Angle With Bone Graftonlay Or Interpositional (Includes Obtainingautograft) Augmentation Mandibular Body Or Angl E With Bone Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21125 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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