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See a sample rate comparisonCPT 21195 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.
Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit Without Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 50 - Bilateral Procedure 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21195 |
| Medicaid Fee Schedule | View Medicaid rates for 21195 |
National average reimbursement for CPT 21195 by major payers:
$1,657.29
$1,821.44
$1,891.70
$2,216.44
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CPT 21195
5 of 25 sample ratesHigher to lower in this preview
North Central Methodist Asc, Lp, Methodist Ambulatory Surgery Center North Central
North Central Methodist Asc Lp
$7,319.00Published rateBronson Ambulatory Surgery Center, LLC, Bronson Orthopedic Surgery Center
Bronson Ambulatory Surgery Center LLC
$4,111.00Published rateCanyon View Asc, LLC, Canyon View Asc
Canyon View Asc LLC
$3,022.00Published rateSalvatore Dimercurio Md PA
Salvatore Dimercurio, M.D., P.A.
$1,556.00Published rateInterventional Pain Center Of Chesterfield L L C
$797.00Published rate
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See a sample payer proposalCPT 21195 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21195 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 21195 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 |
|---|---|---|
| 21193-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Horizontal Vertical C Or L Osteotomy Without Bone Graft Reconstruction Of Mandibular Rami Horizontal Vertical C |
| 21194-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Horizontal Vertical C Or L Osteotomy With Bone Graft (Includes Obtaining Graft) Reconstruction Of Mandibular Rami Horizontal Vertical C |
| 21195-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit Without Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal |
| 21196-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit With Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21195 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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