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See a sample rate comparisonCPT 21423 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.
Open Treatment Of Palatal Or M, Open Treatment Of Palatal Or Maxillary Fracture (Lefort Itype) Complicated (Comminuted Or Involvingcranial Nerve Foramina) Multiple Approaches
| 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 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21423 |
| Medicaid Fee Schedule | View Medicaid rates for 21423 |
National average reimbursement for CPT 21423 by major payers:
$1,003.03
$1,054.98
$1,102.34
$1,305.83
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CPT 21423
5 of 25 sample ratesHigher to lower in this preview
Northshore Regional Medical Center Dba The Surgery Suite, The Surgery Suite
Ochsner Clinic Foundation
$21,412.00Published rateMarion Surgery Center, LLC
Marion Surgery Center LLC
$5,354.00Published rateMidtown Urology Surgical Center, PC
$2,600.00Published rateCentral Maryland Endoscopy LLC
$1,605.00Published rateDigestive Health & Endoscopy Center LLC
$586.00Published rate
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See a sample payer proposalCPT 21423 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21423 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 21423 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 |
|---|---|---|
| 21421-CPT | Moderate | Closed Treatment Of Palatal Or, Closed Treatment Of Palatal Or Maxillary Fracture (Lefort I Type) With Interdental Wire Fixation Orfixation Of Denture Or Splint |
| 21422-CPT | Moderate | Repair And Secure Broken Jaw, Surgery To Repair A Broken Bone Of The Upper Jaw. A Mouth Splint And Dental Wiring Bind The Jaw Shut And Stabilize The Bones. |
| 21423-CPT | High | Open Treatment Of Palatal Or M, Open Treatment Of Palatal Or Maxillary Fracture (Lefort Itype) Complicated (Comminuted Or Involvingcranial Nerve Foramina) Multiple Approaches |
| 21432-CPT | Moderate | Open Treatment Of Craniofacial, Open Treatment Of Craniofacial Separation (Lefort Iii Type)With Wiring Andor Internal Fixation Open Treatment Of Craniofacial Separation (Lefort Iii Type) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21423. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21423 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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