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See a sample rate comparisonCPT 21343 Fee Schedule
Medicare rates as of October 2026
CPT 21343 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Open Treatment Of Depressed Fr, Open Treatment Of Depressed Frontal Sinus Fractureopen Treatment Of Depressed Frontal Sinus Fracture
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | GCService performed by resident under supervision RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5165 - Level 5 ENT Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $974.64 national non-facility rate (2026)View Medicare rates for 21343 |
| Medicaid Fee Schedule | $788.69 median of the 8 states in the free previewView Medicaid rates for 21343 |
National average reimbursement for CPT 21343 by major payers:
$1,455.23
BCBS / Anthem
$1,491.96
UnitedHealthcare
$1,522.38
Aetna
$1,817.23
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21343.
CPT 21343
5 of 25 sample ratesHigher to lower in this preview
Campus Surgery Center LLC
Campus Surgery Center L P
$6,756.00Published rateSurgcenter Of St. Lucie, LLC
$5,354.00Published rateClarksville Surgicenter, LLC
$2,668.00Published rateSurgery Center Of Southwest Florida Inc
$2,050.00Published ratePortsmouth Surgery Center
$1,500.00Published rate
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See a sample payer proposalCPT 21343 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21343. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 21338-CPT | Open Treatment Of Nasoethmoid, Open Treatment Of Nasoethmoid Fracture Without Externalfixation Open Treatment Of Nasoethmoid Fracture Without External |
| 21340-CPT | Percutaneous Treatment Of Naso, Percutaneous Treatment Of Nasoethmoid Complex Fracture Withsplint Wire Or Headcap Fixation Including Repair Of Canthal Ligaments Andor The Nasolacrimal Apparatus |
| 21343-CPT | Open Treatment Of Depressed Fr, Open Treatment Of Depressed Frontal Sinus Fractureopen Treatment Of Depressed Frontal Sinus Fracture |
| 21344-CPT | Open Tx Compl Front Sinus Fx, Open Treatment Of Complicated Eg Comminuted Or Involving Posterior Wall Frontal Sinus Fracture Via Coronal Or Multiple Approaches |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21343. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21343 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 21343 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21343 to APC 5165 (Level 5 ENT Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 21343 in an ambulatory surgery center?
CMS lists CPT 21343 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 21343?
Hospital price transparency files list CPT 21343 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.