CPT code 21125: Mandibular augmentation, prosthetic material2026 Medicare rate & RVUs in Texas
Reports mandibular augmentation using prosthetic material to enlarge or restore jaw contour, rather than augmentation with bone graft or repositioning by osteotomy.
Medicare pays $2,394.40–$2,719.48 for 21125 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
Where 21125 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$2394.40 to $2719.48
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $2,719.48 | $614.03 |
| Beaumont, TX | $2,394.40 | $583.48 |
| Brazoria, TX | $2,569.68 | $597.56 |
| Dallas, TX | $2,584.20 | $602.13 |
| Fort Worth, TX | $2,562.69 | $600.52 |
| Galveston, TX | $2,576.02 | $599.93 |
| Houston, TX | $2,598.17 | $622.07 |
| Rest of Texas | $2,479.29 | $590.75 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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%).
21125 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21127Mandibular augmentationWith bone graft
- Choose 21125 for augmentation with prosthetic material; 21127 describes mandibular augmentation using bone graft.
- 21120Chin augmentationAugmentation without sliding osteotomy
- 21120 describes augmentation performed as a genioplasty. 21125 describes prosthetic augmentation of the mandible rather than chin-focused genioplasty.
- 21123Chin augmentationSliding osteotomy with graft
- 21123 includes a sliding osteotomy along with augmentation. 21125 describes mandibular augmentation with prosthetic material without that osteotomy service.
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
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