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 21268 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.
Orbital Repositioning Periorb, Orbital Repositioning Periorbital Osteotomies Unilateral With Bone Grafts Combined Intra- And Extracranial Approach
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None SC - Medically necessary service or supply 80 - Assistant surgeon 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21268 |
| Medicaid Fee Schedule | View Medicaid rates for 21268 |
National average reimbursement for CPT 21268 by major payers:
$2,499.91
$2,618.71
$2,668.36
$3,211.64
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21268.
CPT 21268
5 of 25 sample ratesHigher to lower in this preview
Mt. Scott Surgery Center, LLC
$6,050.00Published rateWilshire Surgery Center, LLC
Wilshire Surgery Center
$3,950.00Published rateCleaver Medical Group Surgery Center
$2,450.00Published rateDutchess Ambulatory Surgical Center
$1,603.00Published rateAffiliated Ambulatory Surgery Center LLC
Affiliated Ambulatory Surgery Center, LLC
$390.00Published 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 21268 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21268 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 21268 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 |
| 21268-CPT | High | Orbital Repositioning Periorb, Orbital Repositioning Periorbital Osteotomies Unilateral With Bone Grafts 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 21268. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21268 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 21268) and we'll show you how you compare in 15 minutes or less.