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See a sample rate comparisonCPT 21461 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 Mandibular F, Open Treatment Of Mandibular Fracture Without Interdentalfixation Open Treatment Of Mandibular Fracture Without Interdental
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21461 |
| Medicaid Fee Schedule | View Medicaid rates for 21461 |
National average reimbursement for CPT 21461 by major payers:
$2,192.93
$2,549.75
$2,590.12
$1,705.59
Compare published rates across providers.
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CPT 21461
5 of 25 sample ratesHigher to lower in this preview
Kc Pain Asc, LLC
Kc Pain Asc LLC
$7,121.00Published rateAllina Health Surgery Center- Brooklyn Park, LLC
Allina Health Surgery Center Brooklyn Park LLC
$3,877.00Published rateSurgicare Surgical Associates Of Ridgewood, LLC
Surgicare Surgical Associates Of Ridgewood LLC
$3,289.00Published rateEar Nose And Throat Surgery Center LLC
$1,800.00Published rateSuncoast Eye Center PA, Suncoast Surgery Institute
Suncoast Eye Center PA
$520.00Published rate
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See a sample payer proposalCPT 21461 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21461 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 21461 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 |
|---|---|---|
| 21461-CPT | High | Open Treatment Of Mandibular F, Open Treatment Of Mandibular Fracture Without Interdentalfixation Open Treatment Of Mandibular Fracture Without Interdental |
| 21462-CPT | High | 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. |
| 21465-CPT | High | 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. |
| 21470-CPT | High | Open Treatment Of Complicated, Open Treatment Of Complicated Mandibular Fracture Bymultiple Surgical Approaches Including Internal Fixation Interdental Fixation Andor Wiring Of Dentures Or Splints |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21461 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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