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CPT code 21125: Mandibular augmentation, prosthetic material2026 Medicare rate & RVUs in Puerto Rico

Reports mandibular augmentation using prosthetic material to enlarge or restore jaw contour, rather than augmentation with bone graft or repositioning by osteotomy.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Puerto Rico, Medicare pays $2,619.22 for 21125 in the office and $607.30 when it’s performed in a hospital or facility.

$2,619.22Office (non-facility)
$607.30Hospital or facility
+0.9%vs the national office rate ($2,595.58)

Check a contract rate as a % of Medicare · 21125 nationwide

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

We’ll open 21125 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 21125 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 21125 covers

Mandibular augmentation with a prosthetic implant enlarges or restores jaw contour by placing alloplastic material along a deficient segment of the mandible. It is distinct from bone-graft augmentation and from an osteotomy that repositions native jaw segments. Oral and maxillofacial surgeons and plastic surgeons typically perform the procedure in an operating room for reconstructive or contour-correction needs, using an implant selected for the documented mandibular deficiency.

Report 21125 when the operative service augments the mandible with prosthetic material. The note should identify the treated mandibular area, the indication, the implant and its placement, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons and team surgery are 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.

How Puerto Rico compares for 21125

Across 109 of 109 payment localities, the office rate for 21125 runs from $2,265.30 in Arkansas to $3,589.45 in San Benito County, CA. Puerto Rico pays $2,619.22. The RVUs are the same everywhere; the geographic indexes change the dollars.

21125 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$2,619.22
  2. Los Angeles, CA · California$2,999.66+$380.44
  3. Washington, DC area · District of Columbia$3,011.36+$392.14
  4. Miami, FL · Florida$2,747.72+$128.50
  5. Chicago, IL · Illinois$2,661.40+$42.18
  6. Manhattan, NY · New York$2,998.74+$379.52
  7. Alaska · Alaska$2,896.52+$277.30

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

21125 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$2,302.61$561.34
ArkansasArkansas$2,265.30$555.86
ArizonaArizona$2,521.46$593.12
Bakersfield, CACalifornia$2,798.00$616.93
Chico, CACalifornia$2,794.34$613.27
El Centro, CACalifornia$2,794.54$613.48
Fresno, CACalifornia$2,794.34$613.27
Hanford, CACalifornia$2,794.34$613.27

21125 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.

$2,265.30

$3,191.90

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
21125 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,896.521
AL$2,302.611
AR$2,265.301
AZ$2,521.461
CA$2,794.34–$3,589.4529
CO$2,731.971
CT$2,780.771
DC$3,011.361
DE$2,566.821
FL$2,518.96–$2,747.723
GA$2,365.37–$2,640.022
GU$2,880.441
HI$2,880.441
IA$2,383.921
ID$2,398.011
IL$2,426.64–$2,688.744
IN$2,413.961
KS$2,364.011
KY$2,347.561
LA$2,340.49–$2,471.082
MA$2,709.79–$3,033.032
MD$2,622.23–$3,011.363
ME$2,404.03–$2,560.842
MI$2,409.10–$2,546.192
MN$2,631.031
MO$2,290.46–$2,489.903
MS$2,278.761
MT$2,595.501
NC$2,433.361
ND$2,571.581
NE$2,400.781
NH$2,680.871
NJ$2,816.29–$2,973.042
NM$2,420.821
NV$2,591.041
NY$2,473.41–$3,069.185
OH$2,404.211
OK$2,350.801
OR$2,574.77–$2,835.452
PA$2,412.68–$2,700.062
PR$2,619.221
RI$2,670.621
SC$2,422.061
SD$2,568.751
TN$2,376.361
TX$2,394.40–$2,719.488
UT$2,459.251
VA$2,546.24–$3,011.362
VI$2,619.221
VT$2,553.581
WA$2,707.28–$3,105.962
WI$2,475.071
WV$2,324.351
WY$2,585.081

See 21125 in every payment locality

How the 21125 rate is calculated

Each of 21125’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 · 21125

RVUs × geographic indexes × conversion factor

Office or facility?

Work10.53

10.53 RVUs× 1.000 GPCI

Practice expense65.97

65.97 RVUs× 1.000 GPCI

Malpractice1.21

1.21 RVUs× 1.000 GPCI

Adjusted RVUs

77.7100

Conversion factor

$33.4009

Medicare rate

$2,595.58

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,881

Code
21125
Physician work
10.53
Practice expense
65.97
Malpractice
1.21

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 21125 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work10.53× 1.00010.5300
Practice expense65.97× 1.01166.6957
Malpractice1.21× 0.9851.1918
Total RVUs78.4175
Conversion factor× 33.4009

Office rate, Puerto Rico$2619.22

Office: (10.53 × 1 + 65.97 × 1.011 + 1.21 × 0.985) × $33.4009 = $2619.22

Facility: (10.53 × 1 + 6.39 × 1.011 + 1.21 × 0.985) × $33.4009 = $607.30

Open 21125 in the RVU calculator

Payment rules and modifiers for 21125

21125 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21125

Mandibular augmentation, prosthetic material

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)2Paid.
Co-surgeons (62)0Not permitted.
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 · 21125

Mandibular augmentation, prosthetic material

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

21125 without 51 · national office

$2,595.58

Mandibular augmentation, prosthetic material

21125-51 · Second procedure: 50%

$1,297.79

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

Codes related to 21125

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

Codes related to 21125
CodeHow it relatesOffice range, Puerto Rico
Same family
21127Mandibular augmentation, with bone graftMandibular augmentation using bone graft rather than prosthetic material.$4,006.01
Used instead
21120Chin augmentation, augmentation without sliding osteotomyGenioplasty augmentation is appropriate when the procedure is focused on chin augmentation.$720.69
21123Chin augmentation, sliding osteotomy with graftCombines mandibular sliding osteotomy with augmentation rather than prosthetic augmentation alone.No office rate
21121Sliding genioplasty, single-piece osteotomyMandibular sliding osteotomy without the augmentation component described by 21125.$653.58
21122Sliding genioplasty, two or more osteotomiesSliding osteotomy involving multiple segments, rather than prosthetic mandibular augmentation.No office rate

How 21125 has changed in Puerto Rico

21125 · Office / nonfacility

$2619.22

Effective 2026-10-01

The base rate is $141.09 higher than on 2025-10-01, moving from $2478.13 to $2619.22 (5.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $2478.13changed to$2619.22

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 10.80 changed to 10.53
    • Practice expense RVU 64.35 changed to 65.97
    • Malpractice RVU 1.03 changed to 1.21
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $2593.44changed to$2478.13

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 65.61 changed to 64.35
    • Malpractice RVU 1.06 changed to 1.03

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $2551.11changed to$2593.44

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $2693.05changed to$2551.11

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 67.14 changed to 65.61
    • Malpractice RVU 1.01 changed to 1.06
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $2675.39changed to$2693.05

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $2810.30changed to$2675.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 68.92 changed to 67.14
    • Malpractice RVU 0.95 changed to 1.01
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $2928.93changed to$2810.30

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 71.65 changed to 68.92
    • Malpractice RVU 0.93 changed to 0.95

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $2938.87changed to$2928.93

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 69.18 changed to 71.65
    • Malpractice RVU 0.91 changed to 0.93
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $3003.26changed to$2938.87

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 70.23 changed to 69.18
    • Malpractice RVU 1.83 changed to 0.91
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. July 1, 2019

    RVU19C

    $3000.05changed to$3003.26

    • Malpractice RVU 1.74 changed to 1.83

    Held through RVU19D.

  11. January 1, 2019

    RVU19A

    $3056.52changed to$3000.05

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 71.80 changed to 70.23
    • Malpractice RVU 1.82 changed to 1.74

    Held through RVU19B.

  12. January 1, 2018

    RVU18AR1

    $2854.86changed to$3056.52

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 79.12 changed to 71.80
    • Malpractice RVU 1.59 changed to 1.82
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  13. January 1, 2017

    RVU17A

    $2299.96changed to$2854.86

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 75.07 changed to 79.12
    • Malpractice RVU 1.75 changed to 1.59
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  14. January 1, 2016

    RVU16A

    $2366.51changed to$2299.96

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 77.34 changed to 75.07
    • Malpractice RVU 1.82 changed to 1.75

    Held through RVU16B, RVU16C, RVU16D.

  15. July 1, 2015

    RVU15C

    $2354.73changed to$2366.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  16. January 1, 2015

    RVU15A

    $2249.38changed to$2354.73

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 74.33 changed to 77.34
    • Malpractice RVU 2.05 changed to 1.82
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  17. January 1, 2014

    RVU14A

    $2528.79changed to$2249.38

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 92.91 changed to 74.33
    • Malpractice RVU 2.14 changed to 2.05
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  18. January 1, 2013

    RVU13AR

    Earliest loaded release: $2528.79

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$2,619.22$607.30RVU26D
2026-07-01$2,619.22$607.30RVU26C
2026-04-01$2,619.22$607.30RVU26B
2026-01-01$2,619.22$607.30RVU26A
2025-10-01$2,478.13$660.23RVU25D
2025-07-01$2,478.13$660.23RVU25C
2025-04-01$2,478.13$660.23RVU25B
2025-01-01$2,478.13$660.23RVU25A
2024-10-01$2,593.44$667.35RVU24D
2024-07-01$2,593.44$667.35RVU24C
2024-04-01$2,593.44$667.35RVU24B
2024-03-09$2,593.44$667.35RVU24AR
2024-01-01$2,551.11$656.45RVU24A
2023-10-01$2,693.05$674.63RVU23D
2023-07-01$2,675.39$673.00RVU23C
2023-04-01$2,675.39$673.00RVU23B
2023-01-01$2,675.39$673.00RVU23A
2022-10-01$2,810.30$680.69RVU22D
2022-07-01$2,810.30$680.69RVU22C
2022-04-01$2,810.30$680.69RVU22B
2022-01-01$2,810.30$680.69RVU22A
2021-10-01$2,928.93$694.09RVU21D
2021-07-01$2,928.93$694.09RVU21C
2021-04-01$2,928.93$694.09RVU21B
2021-01-01$2,928.93$694.09RVU21A
2020-10-01$2,938.87$719.43RVU20D
2020-07-01$2,938.87$719.43RVU20C
2020-04-01$2,938.87$719.43RVU20B
2020-01-01$2,938.87$719.43RVU20A
2019-10-01$3,003.26$773.88RVU19D
2019-07-01$3,003.26$773.88RVU19C
2019-04-01$3,000.05$770.67RVU19B
2019-01-01$3,000.05$770.67RVU19A
2018-10-01$3,056.52$800.23RVU18D
2018-07-01$3,056.52$800.23RVU18C
2018-04-01$3,056.52$800.23RVU18B
2018-01-01$3,056.52$800.23RVU18AR1
2017-10-01$2,854.86$695.80RVU17D
2017-07-01$2,854.86$695.80RVU17C
2017-04-01$2,854.86$695.80RVU17B
2017-01-01$2,854.86$695.80RVU17A
2016-10-01$2,299.96$662.26RVU16D
2016-07-01$2,299.96$662.26RVU16C
2016-04-01$2,299.96$662.26RVU16B
2016-01-01$2,299.96$662.26RVU16A
2015-10-01$2,366.51$623.59RVU15D
2015-07-01$2,366.51$623.59RVU15C
2015-04-01$2,354.73$620.49RVU15B
2015-01-01$2,354.73$620.49RVU15A
2014-10-01$2,249.38$662.86RVU14D
2014-07-01$2,249.38$662.86RVU14C
2014-04-01$2,249.38$662.86RVU14B
2014-01-01$2,249.38$662.86RVU14A
2013-10-01$2,528.79$625.94RVU13D
2013-07-01$2,528.79$625.94RVU13C
2013-04-01$2,528.79$625.94RVU13B
2013-01-01$2,528.79$625.94RVU13AR

Price 21125 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

21125 billing questions

How does 21125 differ from 21127?

21125 describes mandibular augmentation with prosthetic material. 21127 is the related augmentation code for bone grafting.

When is 21120 a better fit?

Use 21120 for augmentation performed as a genioplasty, such as chin augmentation. Use 21125 when the documented service is mandibular augmentation with prosthetic material.

Can 21125 be reported with modifier 50?

No. CMS identifies bilateral adjustment as inappropriate for this code.

What postoperative care is included?

The 90-day global includes the day-before preoperative visit and related postoperative care through the 90-day period.

Can an assistant surgeon be paid for 21125?

CMS indicates that assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted.

What documentation supports 21125?

Document the mandibular area treated, the indication for augmentation, the prosthetic material and its placement, and the operative work performed.

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 21125PPRRVU2026_Oct_nonQPP.csv, line 1,881 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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