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See a sample rate comparisonCPT 21242 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.
Arthroplasty Temporomandibula, Arthroplasty Temporomandibular Joint With Allograftarthroplasty Temporomandibular Joint With Allograft
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 50 - Bilateral Procedure RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21242 |
| Medicaid Fee Schedule | View Medicaid rates for 21242 |
National average reimbursement for CPT 21242 by major payers:
$1,332.15
$1,370.93
$1,448.69
$1,676.87
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CPT 21242
5 of 25 sample ratesHigher to lower in this preview
Ga Endoscopy Center, LLC
Ga Endoscopy Center LLC
$5,433.00Published rateBoise Center For Foot Surgery PLLC, Millennium Surgery Center
Boise Center For Foot Surgery PLLC
$3,003.00Published rateSoutheast Atlanta Vascular Care, LLC
Southeast Atlanta Vascular Care LLC
$2,546.00Published rateCharlotte Gastroenterology & Hepatology, PLLC
$1,760.00Published rateLiberty Endoscopy Center
Liberty Endoscopy Center, LLC
$987.00Published rate
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See a sample payer proposalCPT 21242 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21242 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 21242 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 |
|---|---|---|
| 21240-CPT | High | Arthroplasty Temporomandibula, Arthroplasty Temporomandibular Joint With Or Withoutautograft (Includes Obtaining Graft) Arthroplasty Temporomandibular Joint With Or Without |
| 21242-CPT | High | Arthroplasty Temporomandibula, Arthroplasty Temporomandibular Joint With Allograftarthroplasty Temporomandibular Joint With Allograft |
| 21243-CPT | High | Arthroplasty Temporomandibula, Arthroplasty Temporomandibular Joint With Prosthetic Jointreplacement Arthroplasty Temporomandibular Joint With Prosthetic Joint |
| 21244-CPT | High | Reconstruct Jaw And Teeth, Surgery To Reconstruct The Jaw Using An Artificial Part With Posts That Extend Through The Upper Or Lower Jaw Into The Mouth. Dentures Are Attached To The Posts To Replace Missing Teeth. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21242 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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