CPT code 21160: Midface reconstruction, leFort III advancement with graft2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $2,396.43 for 21160 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 21160 nationwide

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

What 21160 covers

This operation mobilizes and advances the midface at the LeFort III level, with bone grafting to support the reconstruction. Craniofacial plastic surgeons and oral and maxillofacial surgeons typically perform it in an operating room, often for severe midface retrusion associated with congenital craniofacial conditions or craniosynostosis. The operative record should establish the LeFort III advancement and describe the graft used and its role in the reconstruction.

Select this code when the documented reconstruction includes both LeFort III advancement and bone grafting; distinguish it from related LeFort III procedures based on whether advancement and grafting are performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. 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.

How Puerto Rico compares for 21160

Across 109 of 109 payment localities, the facility rate for 21160 runs from $2,195.04 in Arkansas to $3,101.67 in Alaska. Puerto Rico pays $2,396.43. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

21160 rates by state

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

See 21160 in every payment locality

How the 21160 rate is calculated

Each of 21160’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 21160

21160 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

Codes related to 21160

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

How 21160 has changed in Puerto Rico

Price 21160 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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