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CPT code 21089: Unlisted prosthesis, maxillofacial procedure2026 Medicare rate & RVUs

Reports a maxillofacial prosthetic procedure when no listed CPT code describes the service, rather than a coded impression-and-preparation service for a named prosthesis.

CMS RVU26DEffective Oct 1, 2026109 payment localities292 Medicare services in 2024

Medicare rate · 21089

Unlisted prosthesis, maxillofacial procedure

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
YYY

National rate · 2026

—

Not priced in the facility setting.

See every locality for 21089 →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 9 sections
  1. Medicare rate
  2. What 21089 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Billing questions
  9. Sources

What 21089 covers

Code 21089 identifies an unlisted maxillofacial prosthetic procedure. It is used when the prosthetic work is not described by a more specific listed CPT service. Nearby listed services cover impression and preparation for a surgical obturator, mandibular resection prosthesis, oral surgical splint, nasal prosthesis, and facial prosthesis. Those listed codes apply when the service performed is the corresponding impression-and-preparation service; 21089 is not a general substitute for them. The code identifies neither a named prosthesis nor a fixed unit of service.

Medicare assigns 21089 physician fee schedule status C: CMS publishes no national payment amount, and the Medicare Administrative Contractor prices each claim. The contractor also sets the global period. Report the code for maxillofacial prosthetic work that lacks a more specific listed CPT code.

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 21089 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

21089 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

21089 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
21089 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 21089 rate is calculated

Each of 21089’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 · 21089

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

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

Payment rules and modifiers for 21089

The CMS indicators that decide how 21089 is paid alongside other services.

CMS payment indicators · 21089

Unlisted prosthesis, maxillofacial procedure

RuleCMS valueWhat it means
Global periodYYYThe Medicare contractor sets the global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

21089 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21089

    Unlisted prosthesis, maxillofacial procedure0 wRVU

    Not priced

  • 21088

    Facial prosthesis, impression and preparation0 wRVU

    Not priced

  • 21081

    Mandibular prosthesis, impression and custom preparation22.28 wRVU

    $1,592.22

  • 21085

    Oral splint, surgical use8.77 wRVU

    $710.10

How to choose

21088Facial prosthesisImpression and preparation
21088 covers impression and preparation for a facial prosthesis. Use 21089 when the maxillofacial prosthetic work is not described by that or another listed service.
21081Mandibular prosthesisImpression and custom preparation
21081 covers impression and preparation for a mandibular resection prosthesis. Code 21089 is for maxillofacial prosthetic work without a more specific listed code.
21085Oral splintSurgical use
21085 covers impression and preparation for an oral surgical splint. It is not the unlisted code for other maxillofacial prosthetic work.

21089 billing questions

When should I report 21089 instead of a listed prosthesis code?

Use 21089 when the maxillofacial prosthetic work is not described by a more specific listed CPT service. Listed codes cover specified impression-and-preparation services, such as those for a facial prosthesis or oral surgical splint.

Is 21089 an impression-and-preparation code?

No. Nearby codes describe impression and preparation for specified prostheses; 21089 identifies an unlisted maxillofacial prosthetic procedure.

Does 21089 have a national Medicare payment amount?

No. Its physician fee schedule status is C, so the Medicare Administrative Contractor prices each claim.

Who sets the global period for 21089?

The Medicare contractor sets the global period for this code.

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

Open CMS sourceHow we calculate rates

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