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See a sample rate comparisonCPT 21454 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.
Surgery To Repair Broken Jaw, Surgery To Repair A Broken Jaw Bone. A Mouth Splint Or Dental Wiring May Be Used To Bind The Jaw Shut And Stabilize The Bones.
| 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 | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21454 |
| Medicaid Fee Schedule | View Medicaid rates for 21454 |
National average reimbursement for CPT 21454 by major payers:
$687.88
$714.67
$710.62
$850.52
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CPT 21454
5 of 25 sample ratesHigher to lower in this preview
Hudson Crossing Surgery Center, LLC, Hudson Crossing Surgery Center
Hudson Crossing Surgical Center
$6,000.00Published rateEndoscopy Consultants, LLC
Endoscopy Consultants LLC
$2,353.00Published rateLorain Amherst Surgery Center LLC
$1,632.00Published rateCarter Real Estate Properties Inc, North Dallas Surgicare
Carter Real Estate Properties Inc
$1,100.00Published rateDigestive Health Complex,Inc
$530.00Published rate
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See a sample payer proposalCPT 21454 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21454 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 21454 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 |
|---|---|---|
| 21451-CPT | Moderate | Closed Treatment Of Mandibular, Closed Treatment Of Mandibular Fracture With Manipulationclosed Treatment Of Mandibular Fracture With Manipulation |
| 21452-CPT | Moderate | Percutaneous Treatment Of Mand, Percutaneous Treatment Of Mandibular Fracture With Externalfixation Percutaneous Treatment Of Mandibular Fracture With External |
| 21453-CPT | High | Closed Treatment Of Mandibular, Closed Treatment Of Mandibular Fracture With Interdentalfixation Closed Treatment Of Mandibular Fracture With Interdental |
| 21454-CPT | Moderate | Surgery To Repair Broken Jaw, Surgery To Repair A Broken Jaw Bone. A Mouth Splint Or Dental Wiring May Be Used To Bind The Jaw Shut And Stabilize The Bones. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21454 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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