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See a sample rate comparisonCPT 21296 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) Intraoral Approach
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21296 |
| Medicaid Fee Schedule | View Medicaid rates for 21296 |
National average reimbursement for CPT 21296 by major payers:
$555.08
$548.14
$595.93
$678.39
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CPT 21296
5 of 25 sample ratesHigher to lower in this preview
Eagle Highlands Surgery Center, LLC, Meridian South Surgery Center
$8,705.00Published rateGeorgia Interventional Pain
$1,600.00Published rateRidgecrest Specialty Surgery Center, A Professional Corporation
Ridgecrest Specialty Surgery Center A Professional Corporation
$1,326.00Published rateOphthalmology Center Of Brevard Lp, Asc Of Brevard
Ophthalmology Center Of Brevard Lp
$966.00Published rateThe Surgical Institute Of Monroe Ambulatory Surgery Center LLC, Surgical Institute Of Monroe
Surgical Institute Of Monroe
$500.00Published rate
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See a sample payer proposalCPT 21296 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21296 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 21296 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 21296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21296 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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