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See a sample rate comparisonCPT 21160 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.
Lefort Iii W Fhd W Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts With Lefort I
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | None 62 - Co-Surgeons 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21160 |
| Medicaid Fee Schedule | View Medicaid rates for 21160 |
National average reimbursement for CPT 21160 by major payers:
$3,501.66
$3,809.11
$3,803.16
$4,700.52
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CPT 21160
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Memorial City LLC, Memorial Hermann Memorial Village Surgery Center
$7,770.00Published rateAdvanced Regional Surgery Center, LLC
Advanced Regional Surgery Center LLC
$4,472.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$2,693.00Published rateMusculoskeletal Ambulatory Surgery Center Inc, The Surgery Center At Pointe West
Musculoskeletal Ambulatory Surgery Center
$1,650.00Published rateSurgery Center Of Eye Specialists Of Indiana, PC, Surgery Center
Surgery Center Of Eye Specialists Of Indiana PC
$705.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21160 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21160 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 21160 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 |
|---|---|---|
| 21154-CPT | High | Rcnstj Mdfc Lefort Iii W/O I, Reconstruction Midface Lefort Iii (Extracranial) Any Type Requiring Bone Grafts (Includes Obtaining Autografts); Without Lefort I |
| 21155-CPT | High | Reconstruction Midface Lefort, Reconstruction Midface Lefort Iii (Extracranial)Any Typerequiring Bone Grafts (Includes Obtainin G Autografts) With Lefort I |
| 21159-CPT | High | Lefort Iii W Fhdw O Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts Without Lefort I |
| 21160-CPT | High | Lefort Iii W Fhd W Lefort I, Reconstruction Midface Lefort Iii Extra And Intracranial With Forehead Advancement Eg Mono Bloc Requiring Bone Grafts Includes Obtaining Autografts With Lefort I |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21160 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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