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See a sample rate comparisonCPT 21395 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Opn Tx Orbit Periorbt W/Grft, Open Treatment Of Orbital Floor Blowout Fracture; Periorbital Approach With Bone Graft (Includes Obtaining Graft)
| 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 RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21395 |
| Medicaid Fee Schedule | View Medicaid rates for 21395 |
National average reimbursement for CPT 21395 by major payers:
$1,339.60
$1,338.05
$1,363.76
$1,629.15
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CPT 21395
5 of 25 sample ratesHigher to lower in this preview
Surgical Specialty Center Of Mid Atlantic, LLC
Surgical Specialty Center Of Mid-Atlantic, LLC
$6,286.00Published rateAdvanced Surgical Care Of Clearwater LLC
$5,020.00Published ratePlymouth Orthopedic Surgery Center LLC, Plymouth Orthopedic Surgery Center
Plymouth Orthopedic Surgery Center LLC
$3,806.00Published rateAlliance Surgery Center, LLC
Alliance Surgery Center
$1,800.00Published rateTennessee Pain Surgery Center, LLC
Tennessee Pain Surgery Center LLC
$824.00Published rate
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See a sample payer proposalCPT 21395 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21395 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 21395 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 |
|---|---|---|
| 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 |
| 21395-CPT | High | Opn Tx Orbit Periorbt W/Grft, Open Treatment Of Orbital Floor Blowout Fracture; Periorbital Approach With Bone Graft (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21395. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21395 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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