CPT code 21145: LeFort I reconstruction, single piece with bone graft2026 Medicare rate & RVUs

Medicare pays $1,390.81 for 21145 nationally in a facility.

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

What 21145 covers

This operation repositions the maxilla through a LeFort I osteotomy as one segment and includes bone grafting as part of the reconstruction. Oral and maxillofacial, plastic, or craniofacial surgeons perform it in an operating room for selected maxillary deformities, such as dentofacial disproportion or malocclusion requiring maxillary advancement or repositioning. The one-piece designation reflects the maxilla being mobilized as a single segment.

Select 21145 when the reconstruction is one piece and includes grafting; the related LeFort I codes distinguish reconstructions without grafting and those divided into multiple pieces. The operative report should establish the LeFort I approach, the number of maxillary segments, the repositioning performed, and use of bone graft. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Do not append modifier 50; CMS treats this as a single midface reconstruction. An assistant at surgery may be paid, but co-surgeon and team-surgery payment 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 21145 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

21145 rates by state

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

How the 21145 rate is calculated

Each of 21145’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.

Payment rules and modifiers for 21145

21145 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

21145 compared with similar codes

How to choose

21141Le Fort I reconstructionOne-piece, without graft

Both are one-piece LeFort I reconstructions. Use 21145 when bone grafting is included in the reconstruction; use 21141 without grafting.

21146Midface reconstructionTwo-piece with bone graft

Both include grafting, but 21146 is for a two-piece LeFort I reconstruction; 21145 is for one piece.

21147Midface reconstructionThree or more pieces, with graft

Both include grafting, but 21147 is for three or more pieces; 21145 is for a single-piece reconstruction.

21150Midface reconstructionLeFort II, without graft

21150 describes a LeFort II midface procedure with a different osteotomy pattern, rather than the one-piece LeFort I reconstruction reported with 21145.

Codes related to 21145

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

Open CMS sourceHow we calculate rates