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See a sample rate comparisonCPT 21295 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Reduction Of Masseter Muscle A, Reduction Of Masseter Muscle And Bone (Eg For Treatment Of Benign Masseteric Hypertrophy) Extraoral Approach
| 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 |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21295 |
| Medicaid Fee Schedule | View Medicaid rates for 21295 |
National average reimbursement for CPT 21295 by major payers:
$260.99
$248.83
$260.70
$321.66
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CPT 21295
5 of 25 sample ratesHigher to lower in this preview
Memorial Care Surgical Center At Orange Coast, LLC
Memorial Care Surgical Center At Orange Coast LLC
$3,494.00Published ratePrecision Surgicenter LLC
Precision Surgicenter, LLC
$1,400.00Published ratePrairieland Outpatient Diagnostic Center LLC, Digestive Disease Endoscopy Center
Prairieland Outpatient Diagnostic Center, LLC
$820.00Published rateOak Asc, LLC
Oak Asc LLC
$675.00Published ratePodiatry Group Of Annapolis Ambulatory Surgical Center, Podiatry Group Of Annapolis Ambulatory Surgical Center LLC
Podiatry Group Of Annapolis Ambulatory Surgical Center
$253.00Published rate
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See a sample payer proposalCPT 21295 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21295 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 21295 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 |
|---|---|---|
| 21295-CPT | Moderate | Reduction Of Masseter Muscle A, Reduction Of Masseter Muscle And Bone (Eg For Treatment Of Benign Masseteric Hypertrophy) Extraoral Approach |
| 21296-CPT | Moderate | Reduction Of Masseter Muscle A, Reduction Of Masseter Muscle And Bone (Eg For Treatment Of Benign Masseteric Hypertrophy) Intraoral Approach |
| 21356-CPT | Moderate | Open Treatment Of Depressed Zy, Open Treatment Of Depressed Zygomatic Arch Fracture (Eggillies Approach) Open Treatment Of Depressed Zygomatic Arch Fracture (Eg |
| 21366-CPT | High | Opn Tx Complx Malar W Grft, Open Treatment Of Complicated Eg Comminuted Or Involving Cranial Nerve Foramina Fracture S Of Malar Area Including Zygomatic Arch And Malar Tripod With Bone Grafting Includes Obtaining Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21295. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21295 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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