# CPT 21085: Impression and custom preparation, oral surgical splint

Medicare CPT 21085 pays $710.10 in a non-facility setting and $429.87 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $638.99 in Arkansas to $865.31 in Alaska, a 35% spread.

Web page: https://www.med-reveal.com/rates/21085-cpt-fee-schedule
Section: Surgery and Procedures

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $710.10 |
| National facility | $429.87 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $865.31 | $566.86 |
| District of Columbia | $797.86 | $467.74 |
| New York | $780.94 | $468.30 |
| New Jersey | $776.20 | $460.66 |
| California | $774.15 | $442.56 |
| Washington | $765.20 | $445.73 |
| Massachusetts | $759.96 | $445.13 |
| Connecticut | $752.84 | $451.03 |
| Hawaii | $747.31 | $428.69 |
| Florida | $745.21 | $464.04 |
| Maryland | $732.90 | $440.75 |
| Illinois | $730.81 | $460.04 |
| Colorado | $730.20 | $432.03 |
| Rhode Island | $724.40 | $434.92 |
| Oregon | $722.97 | $427.75 |
| New Hampshire | $721.27 | $429.55 |
| Puerto Rico | $713.76 | $430.45 |
| Virgin Islands | $713.76 | $430.45 |
| Montana | $710.03 | $429.80 |
| Pennsylvania | $707.39 | $432.90 |
| Nevada | $704.52 | $424.00 |
| Delaware | $703.38 | $426.51 |
| Texas | $703.26 | $427.37 |
| Michigan | $701.40 | $438.26 |
| Wyoming | $700.81 | $420.58 |
| Georgia | $700.02 | $432.68 |
| Minnesota | $696.00 | $407.64 |
| Arizona | $693.13 | $421.59 |
| Virginia | $693.11 | $417.64 |
| North Dakota | $688.87 | $408.64 |
| Vermont | $688.63 | $411.20 |
| South Dakota | $686.37 | $406.14 |
| New Mexico | $685.63 | $428.65 |
| Utah | $683.57 | $420.15 |
| Maine | $679.78 | $412.02 |
| Louisiana | $678.60 | $422.75 |
| Missouri | $678.14 | $420.97 |
| Ohio | $677.20 | $421.35 |
| South Carolina | $675.75 | $416.82 |
| West Virginia | $675.54 | $432.02 |
| North Carolina | $671.65 | $410.19 |
| Wisconsin | $669.35 | $400.89 |
| Kentucky | $664.73 | $415.60 |
| Indiana | $663.89 | $404.11 |
| Oklahoma | $661.32 | $411.07 |
| Idaho | $660.75 | $402.94 |
| Tennessee | $658.85 | $404.11 |
| Nebraska | $658.50 | $399.85 |
| Iowa | $656.13 | $399.72 |
| Kansas | $655.76 | $402.43 |
| Mississippi | $647.76 | $406.47 |
| Alabama | $646.91 | $401.71 |
| Arkansas | $638.99 | $398.27 |

## Related codes

- 21010: Arthrotomy, temporomandibular joint — https://www.med-reveal.com/rates/21010-cpt-fee-schedule
- 21031: Excision of torus mandibularis — https://www.med-reveal.com/rates/21031-cpt-fee-schedule
- 21032: Excision of maxillary torus palatinus — https://www.med-reveal.com/rates/21032-cpt-fee-schedule
- 21060: Meniscectomy, partial or complete, temporomandibular joint — https://www.med-reveal.com/rates/21060-cpt-fee-schedule
- 21421: Closed treatment of palatal/alveolar ridge fracture — https://www.med-reveal.com/rates/21421-cpt-fee-schedule
- 21422: Open treatment of palatal/alveolar ridge fracture — https://www.med-reveal.com/rates/21422-cpt-fee-schedule
- 21432: Percutaneous treatment of craniofacial separation — https://www.med-reveal.com/rates/21432-cpt-fee-schedule
- 21440: Closed treatment of mandibular/maxillary alveolar ridge fracture, dental splinting — https://www.med-reveal.com/rates/21440-cpt-fee-schedule

Commercial negotiated rates for 21085 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules