CPT code 21145: LeFort I reconstruction, single piece with bone graft2026 Medicare rate & RVUs in California
Reports one-piece LeFort I maxillary reconstruction with bone grafting when the maxilla is repositioned as a single segment.
CMS doesn’t publish an office rate for 21145 in California.
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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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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $1,409.32 |
| Chico, CA | Unavailable | $1,399.52 |
| El Centro, CA | Unavailable | $1,400.09 |
| Fresno, CA | Unavailable | $1,399.52 |
| Hanford, CA | Unavailable | $1,399.52 |
| Los Angeles, CA | Unavailable | $1,476.04 |
| Madera, CA | Unavailable | $1,399.52 |
| Marin County, CA | Unavailable | $1,608.12 |
| Merced, CA | Unavailable | $1,399.52 |
| Modesto, CA | Unavailable | $1,399.52 |
| Napa, CA | Unavailable | $1,542.86 |
| Oxnard, CA | Unavailable | $1,460.78 |
| Redding, CA | Unavailable | $1,399.52 |
| Rest of California | Unavailable | $1,399.52 |
| Riverside, CA | Unavailable | $1,436.09 |
| Sacramento, CA | Unavailable | $1,447.72 |
| Salinas, CA | Unavailable | $1,441.83 |
| San Benito County, CA | Unavailable | $1,644.45 |
| San Diego, CA | Unavailable | $1,460.17 |
| San Francisco, CA | Unavailable | $1,604.28 |
| San Luis Obispo, CA | Unavailable | $1,420.95 |
| Santa Clara County, CA | Unavailable | $1,628.76 |
| Santa Cruz, CA | Unavailable | $1,461.94 |
| Santa Maria, CA | Unavailable | $1,442.98 |
| Santa Rosa, CA | Unavailable | $1,475.44 |
| Stockton, CA | Unavailable | $1,399.52 |
| Vallejo, CA | Unavailable | $1,537.32 |
| Visalia, CA | Unavailable | $1,399.52 |
| Yuba City, CA | Unavailable | $1,399.52 |
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.
How the rate is built · 21145
RVUs × geographic indexes × conversion factor
Work23.34
23.34 RVUs× 1.000 GPCI
Practice expense14.92
14.92 RVUs× 1.000 GPCI
Malpractice3.38
3.38 RVUs× 1.000 GPCI
Adjusted RVUs
41.6400
Conversion factor
$33.4009
Medicare rate
$1,390.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21145
21145 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21145
LeFort I reconstruction, single piece with bone graft
| 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 · 21145
LeFort I reconstruction, single piece with bone graft
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
21145 without 51 · national facility
$1,390.81
LeFort I reconstruction, single piece with bone graft
21145-51 · Second procedure: 50%
$695.41
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%).
21145 compared with similar codes
Compare codes · National
5 codes, side by side
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.
21145 billing questions
How is 21145 different from 21141?
Both describe a one-piece LeFort I reconstruction. 21145 includes bone grafting; 21141 is the corresponding one-piece reconstruction without grafting.
When should 21146 or 21147 be used instead?
Choose between these grafted LeFort I codes by the number of maxillary pieces: 21145 is one piece, 21146 is two, and 21147 is three or more.
Is bone grafting separately reported with 21145?
Bone grafting is part of the service represented by 21145. The operative report should document that grafting was performed.
What documentation supports the one-piece level?
Document the LeFort I reconstruction, that the maxilla was mobilized as a single segment, the repositioning performed, and the bone grafting.
Can modifier 50 be reported?
No. CMS treats the service as a single midface reconstruction, so modifier 50 is inappropriate.
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.
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
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