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See a sample rate comparisonCPT 21465 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.
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 | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21465 |
| Medicaid Fee Schedule | View Medicaid rates for 21465 |
National average reimbursement for CPT 21465 by major payers:
$1,121.06
$1,178.42
$1,176.89
$1,388.79
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CPT 21465
5 of 25 sample ratesHigher to lower in this preview
Mid-America Surgery Institute LLC
Midamerica Surgery Institute LLC
$7,121.00Published rateSurgcenter Camelback LLC
$5,020.00Published ratePrisma Health Ambulatory Surgery Centers-Midlands, LLC, Prisma Health Orthopedic Surgery Center
Prisma Health Ambulatory Surgery Centersmidlands LLC
$2,967.00Published rateBethesda Surgery Center, LLC
Bethesda Surgery Center LLC
$2,007.00Published rateThe Eye Surgical Center Of Fort Wayne, LLC
The Eye Surgical Center Of Fort Wayne LLC
$635.00Published rate
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See a sample payer proposalCPT 21465 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21465 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 21465 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 21465. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21465 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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