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See a sample rate comparisonCPT 21385 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.
Open Treatment Of Orbital Floo, Open Treatment Of Orbital Floor Blowout Fracturetransantral Approach (Caldwell-Luc Type Operation) Open Treatment Of Orbital Floor Blowout Fracture
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21385 |
| Medicaid Fee Schedule | View Medicaid rates for 21385 |
National average reimbursement for CPT 21385 by major payers:
$961.55
$855.67
$762.95
$1,191.44
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CPT 21385
5 of 25 sample ratesHigher to lower in this preview
Parkcreek Asc LLC
$6,506.00Published rateMidwest Surgery Center, LLC, Midwest Surgery Center- Woodbury
Midwest Surgery Center
$3,429.00Published rateAmbulatory Surgical Ctr Of Aiken LLC, The Surgery Center Of Aiken
$2,295.00Published rateCarlsbad Surgery Center, LLC
$827.00Published rateEye Mds Of Puget Sound PLLC, Narrows Eye Surgery Center
Eye M.D.S Of Puget Sound, PLLC
$544.00Published rate
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See a sample payer proposalCPT 21385 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21385 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 21385 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 |
|---|---|---|
| 21385-CPT | Moderate | Open Treatment Of Orbital Floo, Open Treatment Of Orbital Floor Blowout Fracturetransantral Approach (Caldwell-Luc Type Operation) Open Treatment Of Orbital Floor Blowout Fracture |
| 21386-CPT | Moderate | Open Treatment Of Orbital Floo, Open Treatment Of Orbital Floor Blowout Fractureperiorbital Approach Open Treatment Of Orbital Floor Blowout Fracture |
| 21387-CPT | High | Open Treatment Of Orbital Floo, Open Treatment Of Orbital Floor Blowout Fracture Combinedapproach Open Treatment Of Orbital Floor Blowout Fracture Combined |
| 21390-CPT | High | Open Treatment Of Orbital Floo, Open Treatment Of Orbital Floor Blowout Fractureperiorbital Approach With Alloplastic Or Other Implant Open Treatment Of Orbital Floor Blowout Fracture |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21385. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21385 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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