CPT code 21147: Midface reconstruction, three or more pieces, with graft2026 Medicare rate & RVUs

Medicare pays $1,525.42 for 21147 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 21147 covers

This service reconstructs the midface by mobilizing the maxilla with a LeFort I osteotomy, dividing it into three or more pieces, and using bone grafting as part of the reconstruction. Oral and maxillofacial surgeons, plastic surgeons, or craniofacial surgeons may perform it in an operating room for complex maxillary deformity, such as a developmental midface discrepancy requiring segmental repositioning.

Select this code when the operative report supports both three or more maxillary segments and bone grafting; the number of segments and graft use distinguish it from neighboring LeFort I codes. The record should describe the osteotomy, segment configuration, reconstruction, and grafting. This major surgery has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 21147 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

21147 rates by state

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

How the 21147 rate is calculated

Each of 21147’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 21147

21147 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

21147 compared with similar codes

How to choose

21143LeFort I reconstructionThree or more pieces

Both cover reconstruction in three or more pieces. Choose 21147 when bone grafting is part of the reconstruction; choose 21143 when it is not.

21146Midface reconstructionTwo-piece with bone graft

This is the grafted LeFort I option for two pieces. Use 21147 when the maxilla is reconstructed in three or more pieces.

21145LeFort I reconstructionSingle piece with bone graft

This is the grafted LeFort I option for one piece. Use 21147 when the operative report supports three or more pieces.

Codes related to 21147

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