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CPT code 21046: Mandibular lesion excision, intraoral osteotomy required2026 Medicare rate & RVUs

Reports removal of a benign mandibular cyst or tumor when intraoral osteotomy is required to access and excise the lesion.

CMS RVU26DEffective Oct 1, 2026109 payment localities850 Medicare services in 2024

Medicare pays $899.49 for 21046 nationally in a facility.

Medicare rate · 21046

Mandibular lesion excision, intraoral osteotomy required

Office or facility?

Work RVUs
13.85
Total RVUs
26.93
Global days
090

National rate · 2026

$899.49

Facility setting, before claim adjustments.

See every locality for 21046 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 21046 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 21046 covers

This code describes operative removal of a benign cyst or tumor in the mandible when the surgeon must perform an osteotomy through an intraoral approach to reach or remove it. Oral and maxillofacial surgeons commonly perform the procedure for jaw lesions that cannot be managed by simple enucleation and curettage. The operative report should establish the lesion’s mandibular location and explain the osteotomy and excision performed.

Choose this code based on the documented surgical work and approach, not lesion size alone. A simpler enucleation-and-curettage procedure may fit 21040, while an extraoral osteotomy or resection may point to 21047. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery and co-surgeon payment require supporting documentation; team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 21046 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

21046 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$826.71
AlaskaUnavailable$1,128.97
ArizonaUnavailable$879.30
ArkansasUnavailable$817.66
Atlanta, GAUnavailable$918.74
Austin, TXUnavailable$915.64
Bakersfield, CAUnavailable$921.59
Baltimore area, MDUnavailable$948.42
Beaumont, TXUnavailable$861.28
Brazoria, TXUnavailable$886.85

21046 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
21046 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 21046 rate is calculated

Each of 21046’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 21046

RVUs × geographic indexes × conversion factor

Office or facility?

Work13.85

13.85 RVUs× 1.000 GPCI

Practice expense11.32

11.32 RVUs× 1.000 GPCI

Malpractice1.76

1.76 RVUs× 1.000 GPCI

Adjusted RVUs

26.9300

Conversion factor

$33.4009

Medicare rate

$899.49

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 21046

21046 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21046

Mandibular lesion excision, intraoral osteotomy required

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 21046

Mandibular lesion excision, intraoral osteotomy required

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

21046 without 51 · national facility

$899.49

Mandibular lesion excision, intraoral osteotomy required

21046-51 · Second procedure: 50%

$449.75

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

21046 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21046

    Mandibular lesion excision, intraoral osteotomy required13.85 wRVU

    Not priced

  • 21040

    Mandibular lesion excision, intraoral approach4.79 wRVU

    $479.97

  • 21047

    Jaw cyst excision, lower jaw, intraoral approach19.57 wRVU

    Not priced

  • 21048

    Maxillary excision, extraoral approach, partial maxillectomy14.34 wRVU

    Not priced

How to choose

21040Mandibular lesion excisionIntraoral approach
Use 21040 for mandibular benign cyst or tumor removal by enucleation and curettage. Choose 21046 when the documented procedure requires intraoral osteotomy.
21047Jaw cyst excisionLower jaw, intraoral approach
Both concern benign mandibular cysts or tumors, but 21047 describes work requiring an extraoral osteotomy and/or resection rather than the intraoral approach in 21046.
21048Maxillary excisionExtraoral approach, partial maxillectomy
21048 concerns a benign cyst or tumor in the maxilla requiring intraoral osteotomy; 21046 is for the mandible.

Codes related to 21046

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 21046
CodeHow it relatesNational office range
Used instead
21040Mandibular lesion excision, intraoral approachFor mandibular benign cyst or tumor removal by enucleation and curettage without the osteotomy approach.$428.07–$621.15
Same family
21047Jaw cyst excision, lower jaw, intraoral approachMandibular benign lesion removal requiring an extraoral osteotomy and/or resection.No office rate
21048Maxillary excision, extraoral approach, partial maxillectomyCorresponding intraoral-osteotomy approach for a benign cyst or tumor of the maxilla.No office rate
21049Maxillary cyst excision, with extraoral approach and repairCorresponding extraoral-osteotomy or resection approach for a benign cyst or tumor of the maxilla.No office rate

21046 billing questions

When should 21046 be selected instead of 21040?

Use 21046 when the operative work requires intraoral osteotomy to access or remove the mandibular lesion. 21040 describes removal by enucleation and curettage without that level of approach.

How does 21046 differ from 21047?

21046 describes the intraoral osteotomy approach. 21047 is the neighboring mandibular code for a lesion requiring extraoral osteotomy and/or resection.

What documentation supports 21046?

Document the benign cyst or tumor’s mandibular location, the intraoral approach, the osteotomy performed, and the excision. The operative note should make clear why simple enucleation and curettage was insufficient.

Can modifier 50 be reported?

No. Modifier 50 is inappropriate for this code; report the service based on the mandibular lesion and work performed.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period. Separately reportable care must be outside those included services.

When may an assistant or co-surgeon be paid?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 21046PPRRVU2026_Oct_nonQPP.csv, line 1,853 (RVU26D)

Open CMS sourceHow we calculate rates

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