Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 21243 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 Prosthetic Jointreplacement Arthroplasty Temporomandibular Joint With Prosthetic Joint
| 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 RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21243 |
| Medicaid Fee Schedule | View Medicaid rates for 21243 |
National average reimbursement for CPT 21243 by major payers:
$2,287.38
$2,220.27
$2,377.45
$2,723.79
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21243.
CPT 21243
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
$6,731.00Published rateThe Blue Ridge Clemson Orthopaedic Asc LLC, Blue Ridge Surgery Center
The Blue Ridge Clemson Orthopaedic Asc LLC
$3,606.00Published rateAlderwood Surgery Center LLC
Alderwood Surgical Center
$2,689.00Published rateAmelia Island Surgery Center LLC
$1,600.00Published rateEndoscopy Asc Of Middle Georgia LLC
$741.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 21243 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21243 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 21243 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 21243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21243 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 21243) and we'll show you how you compare in 15 minutes or less.