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See a sample rate comparisonCPT 21431 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.
Closed Treatment Of Craniofaci, Closed Treatment Of Craniofacial Separation (Lefort Iiitype) Using Interdental Wire Fixation Of Denture Or Splint Closed Treatment Of Craniofacial Separation (Lefort Iii
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service 79 - Unrelated procedure - postop period AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21431 |
| Medicaid Fee Schedule | View Medicaid rates for 21431 |
National average reimbursement for CPT 21431 by major payers:
$883.50
$944.14
$960.35
$1,162.20
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CPT 21431
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy & Surgery Center North Houston, LLC, North Houston Endoscopy & Surgery Center
$8,825.00Published rateStuart Surgery Center, LLC
Stuart Surgery Center LLC
$3,393.00Published rateAmerican Access Care Of New Jersey, LLC, Azura Surgery Center Cherry Hill
American Access Care Of New Jersey LLC
$2,460.00Published rateRoanoke Valley Center For Sight LLC
$1,379.00Published rateSally K Balin Ambulatory Surgical Center Inc
Sally K Balin Ambulatory Surgical Center Inc.
$550.00Published rate
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See a sample payer proposalCPT 21431 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21431 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 21431 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 |
|---|---|---|
| 21431-CPT | Moderate | Closed Treatment Of Craniofaci, Closed Treatment Of Craniofacial Separation (Lefort Iiitype) Using Interdental Wire Fixation Of Denture Or Splint Closed Treatment Of Craniofacial Separation (Lefort Iii |
| 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) |
| 21433-CPT | High | Treat Craniofacial Fracture, Open Treatment Of Craniofacial Separation Lefort Iii Type Complicated Eg Comminuted Or Involving Cranial Nerve Foramina Multiple Surgical Approaches |
| 21436-CPT | High | Treat Craniofacial Fracture, Open Treatment Of Craniofacial Separation Lefort Iii Type Complicated Multiple Surgical Approaches Internal Fixation With Bone Grafting 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 21431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21431 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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