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See a sample rate comparisonCPT 21245 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 51 - Multiple procedures KX - Requirements specified in the medical policy have been met |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21245 |
| Medicaid Fee Schedule | View Medicaid rates for 21245 |
National average reimbursement for CPT 21245 by major payers:
$1,511.93
$1,555.99
$1,621.71
$1,569.62
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CPT 21245
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Sugar Land LLP
$7,770.00Published rateAtlantic Coast Surgical Suites, LLC
Atlantic Coast Surgical Suites LLC
$5,433.00Published rateJackson Heart And Vascular Center LLC
$2,520.00Published rateAffiliated Physicians & Surgeons, Ltd
Affiliated Physicians Surgeons Ltd
$1,783.00Published rateCei Physicians Psc, LLC
Cincinnati Eye Institute
$753.00Published rate
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See a sample payer proposalCPT 21245 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21245 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 21245 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 |
| 21245-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 21245. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21245 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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