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See a sample rate comparisonCPT 21355 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.
Percutaneous Treatment Of Fra, Percutaneous Treatment Of Fracture Of Malar Areaincludingzygomatic Arch And Malar Tripod With Ma Nipulation Percutaneous Treatment Of Fracture Ofmalar Area Including
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21355 |
| Medicaid Fee Schedule | View Medicaid rates for 21355 |
National average reimbursement for CPT 21355 by major payers:
$560.20
$568.40
$593.65
$538.01
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CPT 21355
5 of 25 sample ratesHigher to lower in this preview
The Endoscopy Center At St. Francis, LLC
The Endoscopy Center At St Francis LLC
$15,320.00Published rateBsc Reid Park LLC
$4,014.00Published rateRaymond Renaissance Surgery Center LLC
Raymond Renaissance Surgery Ce
$2,978.00Published rateTri City Surgery Center LLC
Tri-City Surgery Center LLC
$2,060.00Published rateAdrian Thodoropoulos
Deaconess Hospital Inc
$343.63Published rate
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See a sample payer proposalCPT 21355 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21355 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 21355 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 |
|---|---|---|
| 21340-CPT | High | Percutaneous Treatment Of Naso, Percutaneous Treatment Of Nasoethmoid Complex Fracture Withsplint Wire Or Headcap Fixation Including Repair Of Canthal Ligaments Andor The Nasolacrimal Apparatus |
| 21355-CPT | Moderate | Percutaneous Treatment Of Fra, Percutaneous Treatment Of Fracture Of Malar Areaincludingzygomatic Arch And Malar Tripod With Ma Nipulation Percutaneous Treatment Of Fracture Ofmalar Area Including |
| 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 |
| 21365-CPT | High | Opn Tx Complx Malar Fx, Open Treatment Of Complicated Eg Comminuted Or Involving Cranial Nerve Foramina Fracture S Of Malar Area Including Zygomatic Arch And Malar Tripod With Internal Fixation And Multiple Surgical Approaches |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21355 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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