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See a sample rate comparisonCPT 21260 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.
Periorbital Osteotomies For Orbital Hypertelorism W/ Bone Grafts, Periorbital Osteotomies For Orbital Hypertelorism With Bone Grafts; E
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery 78 - Return to OR - related procedure 26 - Professional component 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21260 |
| Medicaid Fee Schedule | View Medicaid rates for 21260 |
National average reimbursement for CPT 21260 by major payers:
$1,638.43
$1,791.15
$1,838.96
$2,197.39
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CPT 21260
5 of 25 sample ratesHigher to lower in this preview
Surgicare Of St Andrews Ltd
$7,391.00Published rateNorth Valley Orthopedic Surgery Center LLC, The Orthopedic Surgery Center Of Arizona
North Valley Orthopedic Surgery Center LLC
$5,249.00Published ratePremier Surgery Center, LLC
Premier Surgery Center LLC
$3,268.00Published rateHigh Resort Eye Surgery Center LLC
$2,109.00Published rateAtlantic Surgery Center,LLC
Atlantic Surgery Centerllc
$800.00Published rate
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See a sample payer proposalCPT 21260 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21260 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 21260 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 |
|---|---|---|
| 21255-CPT | High | Reconstruction With Bone Graft, Surgery To Reconstruct The Face Just Below The Cheekbone Using Bone And Cartilage From The Hip Rib Or Skull. |
| 21256-CPT | High | Reconstruction Of Orbit With O, Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Grafts (Includes Obtaining Autografts) (Eg Microophthalmia) |
| 21260-CPT | High | Periorbital Osteotomies For Orbital Hypertelorism W/ Bone Grafts, Periorbital Osteotomies For Orbital Hypertelorism With Bone Grafts; E |
| 21261-CPT | High | Periorbital Osteotomies For Or, Periorbital Osteotomies For Orbital Hypertelorismwith Bonegrafts Combined Intra- And Extracranial Approach |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21260 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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