How much does Medicare pay for CPT 21235?

Medicare allowed an average of $700.87 per service and paid $556.63 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3359.71, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 21235?

Obtaining ear cartilage for grafting. It was billed 1,422 times to 1,379 Medicare beneficiaries by 85 providers in 2024.

Does 21235 pay differently in an office than a hospital?

Yes. The allowed amount averaged $506.13 in an office setting and $762.78 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 21235 most?

Otolaryngology, with 705 services from 46 clinicians. Next are Ambulatory Surgical Center, Micrographic Dermatologic Surgery, Dermatology.

CPT 21235

Obtaining ear cartilage for grafting

$700.87Medicare-allowed amount per service, averaged across 1,422 services

Providers submitted

$3359.71

Asking price, not received

Medicare allowed

$700.87

The fee schedule figure

Medicare paid

$556.63

Balance is patient coinsurance

Providers submitted an average of $3359.71 for this code and Medicare allowed $700.87 — 4.8× 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 $556.63 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $506.13
Hospital / facility: $762.78

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 343 services were billed in an office setting and 1,079 in a facility.

Services: 1,422
Beneficiaries: 1,379
Providers billing it: 85
Total allowed: $996,637

What Medicare pays for CPT 21235

Across 1,422 services billed by 85 providers to 1,379 beneficiaries, Medicare allowed an average of $700.87 per service. 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 21235

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	705	679	$280.33	46
Ambulatory Surgical Center	310	302	$1942.16	18
Micrographic Dermatologic Surgery	148	146	$484.60	7
Dermatology	146	144	$587.76	10
Plastic and Reconstructive Surgery	94	90	$356.96	3
Neurology	19	18	$308.12	1

21235 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
Washington	238	$1233.10	$951.75	10
Florida	111	$662.52	$575.87	8
California	107	$797.99	$571.36	7
South Carolina	95	$307.33	$260.61	4
Delaware	69	$793.21	$620.51	4
Illinois	68	$475.15	$350.79	5
Texas	67	$753.27	$630.01	5
Oklahoma	66	$447.30	$371.43	3
Virginia	59	$816.74	$652.83	3
Tennessee	55	$822.46	$732.43	4
Massachusetts	52	$350.73	$255.46	4
Arizona	51	$715.78	$576.07	3
North Carolina	44	$440.47	$373.82	2
Alabama	35	$695.11	$611.13	2
Arkansas	33	$1017.13	$875.41	2
Michigan	33	$305.80	$237.82	2
Missouri	28	$272.67	$224.17	2
Georgia	28	$282.86	$226.42	2
Utah	23	$863.55	$710.74	2
Kentucky	22	$244.55	$226.47	1
Nevada	18	$651.18	$511.13	1
Iowa	18	$259.61	$224.14	1
Louisiana	15	$268.82	$223.49	1
Ohio	14	$275.32	$218.23	1
Nebraska	14	$265.20	$228.19	1
Indiana	12	$682.61	$580.67	1
Maryland	12	$1668.21	$2164.26	1
New York	12	$702.08	$440.46	1
Oregon	12	$317.33	$237.34	1
Pennsylvania	11	$295.04	$223.63	1

Related codes

21210Repair of nasal or cheek bone$1597.67
21215Repair of lower jaw bone$3862.32

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.