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See a sample rate comparisonCPT 21198 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.
Osteotomy Mandible Segmental
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21198 |
| Medicaid Fee Schedule | View Medicaid rates for 21198 |
National average reimbursement for CPT 21198 by major payers:
$1,352.21
$1,505.20
$1,555.05
$1,758.23
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CPT 21198
5 of 25 sample ratesHigher to lower in this preview
The Emory Clinic Inc, Emory Orthopaedic Surgery Center
Emory University
$4,041.00Published rateOrthoarizona Surgery Center Gilbert, LLC, Orthoarizona Surgery Center Gilbert
Orthoarizona Surgery Center Gilbert LLC
$2,353.00Published rateCrossroads Surgery Center Inc
$1,530.00Published rateFresenius Vascular Care Of Pensacola Asc LLC, Azura Surgery Center Renalus Pensacola
Fresenius Vascular Care Of Pensacola Asc LLC
$1,100.00Published rateNorth Pinellas Surgery Center LLC
North Pinellas Surgery Center, LLC
$485.00Published rate
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See a sample payer proposalCPT 21198 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21198 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 21198 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 |
| 21198-CPT | High | Osteotomy Mandible Segmental |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21198. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21198 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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