How much does Medicare pay for CPT 21215?

Medicare allowed an average of $3862.32 per service and paid $3070.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6621.35, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 21215?

Repair of lower jaw bone with bone graft. It was billed 1,413 times to 938 Medicare beneficiaries by 34 providers in 2024.

Does 21215 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4112.57 in an office setting and $390.42 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 21215 most?

Oral Surgery (Dentist only), with 1,108 services from 24 clinicians. Next are Dentist, Maxillofacial Surgery, General Practice.

CPT 21215

Repair of lower jaw bone with bone graft

$3862.32Medicare-allowed amount per service, averaged across 1,413 services

Providers submitted

$6621.35

Asking price, not received

Medicare allowed

$3862.32

The fee schedule figure

Medicare paid

$3070.75

Balance is patient coinsurance

Providers submitted an average of $6621.35 for this code and Medicare allowed $3862.32 — 1.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $3070.75 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4112.57
Hospital / facility: $390.42

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,318 services were billed in an office setting and 95 in a facility.

Services: 1,413
Beneficiaries: 938
Providers billing it: 34
Total allowed: $5,457,458

What Medicare pays for CPT 21215

Across 1,413 services billed by 34 providers to 938 beneficiaries, Medicare allowed an average of $3862.32 per service. That is 1.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 21215

Specialty	Services	Beneficiaries	Avg allowed	Providers
Oral Surgery (Dentist only)	1,108	735	$3801.19	24
Dentist	173	102	$3992.31	5
Maxillofacial Surgery	101	74	$4064.83	4
General Practice	31	27	$4662.24	1

21215 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	937	$3981.86	$2563.61	21
Arizona	97	$2916.08	$1594.34	2
Oregon	69	$3186.84	$1689.07	1
Colorado	57	$3265.87	$1863.46	1
New Jersey	49	$4602.73	$3162.09	1
Texas	44	$3945.75	$3082.90	2
Nevada	39	$3911.61	$3080.68	1
New Mexico	33	$3408.11	$2766.13	1
Florida	27	$3969.55	$3122.98	1
Washington	25	$4769.51	$3170.59	1
Michigan	21	$3962.09	$3172.66	1
Maryland	15	$4250.74	$3152.73	1

Related codes

21210Repair of nasal or cheek bone$1597.67
21235Obtaining ear cartilage for grafting$700.87

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.