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See a sample rate comparisonCPT 21315 Fee Schedule
Medicare rates as of October 2026
CPT 21315 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Closed Treatment Of Nasal Bon, Closed Treatment Of Nasal Bone Fracture Withoutstabilization Closed Treatment Of Nasal Bone Fracture Without
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 23Emergency Room |
| Common Modifiers | 54Surgical Care Only 59Distinct Procedural Service |
| Hospital Outpatient Group (APC) | APC 5163 - Level 3 ENT Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 04500360Sign up to view all 10 |
| Medicare Fee Schedule | $159.99 national non-facility rate (2026)View Medicare rates for 21315 |
| Medicaid Fee Schedule | $128.14 median of the 8 states in the free previewView Medicaid rates for 21315 |
National average reimbursement for CPT 21315 by major payers:
$235.67
BCBS / Anthem
$343.59
UnitedHealthcare
$305.68
Aetna
$322.74
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21315.
CPT 21315
5 of 25 sample ratesHigher to lower in this preview
St Davids Austin Area Asc LLC, St . David'S Austin Surgery Center
St Davids Austin Area Asc LLC
$2,622.00Published rateSurgicare Of Miramar LLC
$1,276.00Published rateSullivan Surgicenter,LLC
Sullivan Surgicenter LLC
$789.00Published rateTec North, LLC, The Endoscopy Center North
Tec North LLC
$667.00Published rateOutpatient Eye Surgery Center
$450.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 21315 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21315. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21315-CPT | Closed Treatment Of Nasal Bon, Closed Treatment Of Nasal Bone Fracture Withoutstabilization Closed Treatment Of Nasal Bone Fracture Without |
| 21320-CPT | Closed Treatment Of Nasal Bone, Closed Treatment Of Nasal Bone Fracture With Stabilization Closed Treatment Of Nasal Bone Fracturewith Stabilization |
| 21330-CPT | Open Treatment Of Nasal Fractu, Open Treatment Of Nasal Fracture Complicated With Internalandor External Skeletal Fixation Open Treatment Of Nasal Fracture Complicated With Internal |
| 21335-CPT | Open Treatment Of Nasal Fractu, Open Treatment Of Nasal Fracture With Concomitantopentreatment Of Fractured Septum Open Treatment Of Nasal Fracture With Concomitant Open |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21315 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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Frequently Asked Questions
What APC is CPT 21315 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21315 to APC 5163 (Level 3 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21315 in an ambulatory surgery center?
CMS lists CPT 21315 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21315?
Hospital price transparency files list CPT 21315 under these revenue codes: including 0450, 0360, 0981, 0761 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.