CPT code 21159: Midface reconstruction, leFort III advancement, no graft2026 Medicare rate & RVUs in Missouri
Reports LeFort III midface reconstruction with advancement and no bone graft, commonly performed to correct severe midface retrusion in craniofacial conditions.
CMS doesn’t publish an office rate for 21159 in Missouri.
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 21159 covers
This operation mobilizes and advances the midface at the LeFort III level without a bone graft. Craniofacial, oral and maxillofacial, or plastic surgeons may perform it for substantial midface retrusion, including deformity associated with syndromic craniosynostosis. It is a major reconstructive procedure generally performed in a hospital operating room.
Select this code when the operative report supports LeFort III reconstruction with advancement and documents that no bone graft was used. Distinguish it from the non-advancement LeFort III codes and from the advancement code that includes grafting. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures are performed 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 for this service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 21159 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $2,168.82 |
| Metropolitan St. Louis, MO | Unavailable | $2,181.75 |
| Rest of Missouri | Unavailable | $2,122.01 |
How the 21159 rate is calculated
Each of 21159’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 · 21159
RVUs × geographic indexes × conversion factor
Work42.06
42.06 RVUs× 1.000 GPCI
Practice expense17.96
17.96 RVUs× 1.000 GPCI
Malpractice6.15
6.15 RVUs× 1.000 GPCI
Adjusted RVUs
66.1700
Conversion factor
$33.4009
Medicare rate
$2,210.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21159
21159 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21159
Midface reconstruction, leFort III advancement, no 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) | 1 | Permitted with supporting documentation. |
| 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 · 21159
Midface reconstruction, leFort III advancement, no 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
21159 without 51 · national facility
$2,210.14
Midface reconstruction, leFort III advancement, no graft
21159-51 · Second procedure: 50%
$1,105.07
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%).
21159 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21154Midface reconstructionLe Fort III, no interpositional graft
- Choose 21159 for LeFort III advancement without a bone graft. Code 21154 describes LeFort III reconstruction without the advancement distinction and without grafting.
- 21155Midface reconstructionLeFort III, with interpositional graft
- Code 21155 describes LeFort III reconstruction with a bone graft but without the advancement distinction. For advancement with a graft, use 21160 instead.
- 21160Midface reconstructionLeFort III advancement with graft
- Both codes describe LeFort III advancement; 21159 is the no-graft version, while 21160 includes bone grafting.
21159 billing questions
How does 21159 differ from 21154?
21159 describes LeFort III reconstruction with advancement and no bone graft. 21154 is the LeFort III reconstruction code without the advancement distinction.
When should 21160 be reported instead?
Use 21160 when the LeFort III advancement includes a bone graft. The operative report should establish whether a graft was used.
Can modifier 50 be used for bilateral work?
No. Modifier 50 is inappropriate for this code; the descriptor and anatomy do not support bilateral adjustment.
Is an assistant at surgery payable?
CMS permits assistant-at-surgery payment for this procedure. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple procedure reduction.
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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