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CPT code 21151: Midface reconstruction, leFort II with bone graft2026 Medicare rate & RVUs

Reconstructs the midface using a LeFort II osteotomy and bone graft, typically for significant midface deficiency requiring skeletal advancement or rebuilding.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,553.81 for 21151 nationally in a facility.

Medicare rate · 21151

Midface reconstruction, leFort II with bone graft

Office or facility?

Work RVUs
28.29
Total RVUs
46.52
Global days
090

National rate · 2026

$1,553.81

Facility setting, before claim adjustments.

See every locality for 21151 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 21151 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 21151 covers

This operation reconstructs the central midface by repositioning the LeFort II segment and using bone graft to support the skeletal repair. Craniofacial and oral and maxillofacial surgeons may perform it for substantial midface hypoplasia, including deficiency associated with craniofacial syndromes. It is generally performed in an operating room, with the operative report identifying the osteotomy, graft use, and reconstructed anatomy.

Report 21151 when the documented reconstruction is a LeFort II procedure with bone graft; the surgical approach and grafting must support that selection rather than a different LeFort level or configuration. The code includes obtaining an autograft, so do not separately report the harvest as an independent service. The day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 21151 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

21151 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,435.07
AlaskaUnavailable$1,994.94
ArizonaUnavailable$1,519.35
ArkansasUnavailable$1,420.50
Atlanta, GAUnavailable$1,591.91
Austin, TXUnavailable$1,567.29
Bakersfield, CAUnavailable$1,563.04
Baltimore area, MDUnavailable$1,636.00
Beaumont, TXUnavailable$1,501.63
Brazoria, TXUnavailable$1,526.78

21151 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
21151 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 21151 rate is calculated

Each of 21151’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 · 21151

RVUs × geographic indexes × conversion factor

Office or facility?

Work28.29

28.29 RVUs× 1.000 GPCI

Practice expense14.10

14.10 RVUs× 1.000 GPCI

Malpractice4.13

4.13 RVUs× 1.000 GPCI

Adjusted RVUs

46.5200

Conversion factor

$33.4009

Medicare rate

$1,553.81

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

Payment rules and modifiers for 21151

21151 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21151

Midface reconstruction, leFort II with bone graft

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 · 21151

Midface reconstruction, leFort II 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.

  • 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

21151 without 51 · national facility

$1,553.81

Midface reconstruction, leFort II with bone graft

21151-51 · Second procedure: 50%

$776.91

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

21151 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21151

    Midface reconstruction, leFort II with bone graft28.29 wRVU

    Not priced

  • 21150

    Midface reconstruction, leFort II, without graft25.31 wRVU

    Not priced

  • 21145

    LeFort I reconstruction, single piece with bone graft23.34 wRVU

    Not priced

  • 21154

    Midface reconstruction, le Fort III, no interpositional graft30.51 wRVU

    Not priced

How to choose

21150Midface reconstructionLeFort II, without graft
Both involve LeFort II reconstruction, but 21150 identifies an anterior-intrusion configuration; 21151 is the bone-graft configuration. Follow the operative details.
21145LeFort I reconstructionSingle piece with bone graft
This is a one-piece LeFort I reconstruction with graft. Use 21151 when the documented osteotomy and reconstruction are LeFort II.
21154Midface reconstructionLe Fort III, no interpositional graft
This describes LeFort III reconstruction without LeFort I involvement. The operative level and extent, not the general goal of midface advancement, determine the choice.

Codes related to 21151

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

Codes related to 21151
CodeHow it relatesNational office range
Used instead
21150Midface reconstruction, leFort II, without graftLeFort II reconstruction specifying anterior intrusion rather than the bone-graft configuration.No office rate
21145LeFort I reconstruction, single piece with bone graftLeFort I midface reconstruction with graft, for a different osteotomy level and one-piece configuration.No office rate
21154Midface reconstruction, le Fort III, no interpositional graftLeFort III midface reconstruction without LeFort I involvement, for a more extensive skeletal level.No office rate
21155Midface reconstruction, leFort III, with interpositional graftLeFort III reconstruction with LeFort I involvement, rather than the LeFort II procedure.No office rate

21151 billing questions

How do I distinguish 21151 from 21150?

21151 describes LeFort II reconstruction with bone graft. Code 21150 identifies the LeFort II anterior-intrusion configuration; select based on the documented operation, not simply whether both procedures involve the midface.

Can the autograft harvest be reported separately?

No. The code includes obtaining an autograft, so the harvest is part of the reported reconstruction.

Does the code include postoperative care?

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

Can modifier 50 be used for bilateral work?

No. The descriptor and anatomy make a bilateral adjustment with modifier 50 inappropriate.

How are other same-session procedures paid?

The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.

Can an assistant or another surgeon be reported?

An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.

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 21151PPRRVU2026_Oct_nonQPP.csv, line 1,893 (RVU26D)

Open CMS sourceHow we calculate rates

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