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See a sample rate comparisonCPT 21345 Fee Schedule
Medicare rates as of October 2026
CPT 21345 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Closed Treatment Of Nasomaxill, Closed Treatment Of Nasomaxillary Complex Fracture(Lefortii Type) With Interdental Wire Fixation O R Fixation Of Denture Or Splint
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 11Office 22On Campus Outpatient Hospital |
| Common Modifiers | 51Multiple procedures 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 | 03600361Sign up to view all 3 |
| Medicare Fee Schedule | $799.28 national non-facility rate (2026)View Medicare rates for 21345 |
| Medicaid Fee Schedule | $639.19 median of the 8 states in the free previewView Medicaid rates for 21345 |
National average reimbursement for CPT 21345 by major payers:
$935.77
BCBS / Anthem
$1,044.59
UnitedHealthcare
$1,063.30
Aetna
$1,055.25
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 21345.
CPT 21345
5 of 25 sample ratesHigher to lower in this preview
Ochsner Medical Center, Ochsner Outpatient Surgery Suite
Ochsner Clinic Foundation
$3,825.00Published ratePotomac View Surgery Center, LLC
Potomac View Surgery Center LLC
$1,258.00Published rateWest Wilshire Medical Surgical Center Inc.
West Wilshire Medical Surgical C
$1,000.00Published ratePiedmont Outpatient Surgery Center, LLC
Piedmont Outpatient Surgery Center LLC
$729.00Published rateBay Area Endoscopy Center Limited Partnership
$343.00Published rate
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See a sample payer proposalCPT 21345 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 21345. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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 |
| 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 |
| 21345-CPT | Closed Treatment Of Nasomaxill, Closed Treatment Of Nasomaxillary Complex Fracture(Lefortii Type) With Interdental Wire Fixation O R Fixation Of Denture Or Splint |
| 21346-CPT | Reposition Broken Bone In Face, Surgery To Repair A Fracture That Breaks The Cheekbone Below The Eye Socket And Runs Across The Bridge Of The Nose. Dental Wiring May Be Used To Bind The Jaw Shut And Stabilize The Bones. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21345. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21345 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 21345 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 21345 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 21345 in an ambulatory surgery center?
CMS lists CPT 21345 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 21345?
Hospital price transparency files list CPT 21345 under these revenue codes: 0360, 0361 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.