CPT code 21181: Cranial reconstruction, benign tumor contouring2026 Medicare rate & RVUs in Texas
Reconstructs and contours the external cranial bone after treatment of a benign tumor when the resulting bony shape requires surgical correction.
CMS doesn’t publish an office rate for 21181 in Texas.
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 21181 covers
This service addresses contour deformity of the external cranial bones associated with a benign tumor, such as an irregular skull contour after tumor treatment. A craniofacial or plastic surgeon, or a neurosurgeon with reconstructive expertise, reshapes or reconstructs the affected cranial area in an operative setting. The work is directed at the bony contour rather than simply removing the tumor.
Report 21181 when the operation performs the specific cranial contour reconstruction for a benign tumor; documentation should identify the tumor-related deformity, the cranial site, and the reconstructive work performed. Tumor excision is a distinct service and should be evaluated separately when performed. Medicare assigns a 90-day global period, which includes 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 other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment requires documented medical necessity.
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 21181 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $682.28 |
| Beaumont, TX | Unavailable | $643.45 |
| Brazoria, TX | Unavailable | $659.22 |
| Dallas, TX | Unavailable | $665.78 |
| Fort Worth, TX | Unavailable | $663.83 |
| Galveston, TX | Unavailable | $662.75 |
| Houston, TX | Unavailable | $696.80 |
| Rest of Texas | Unavailable | $652.60 |
How the 21181 rate is calculated
Each of 21181’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 · 21181
RVUs × geographic indexes × conversion factor
Work10.02
10.02 RVUs× 1.000 GPCI
Practice expense8.26
8.26 RVUs× 1.000 GPCI
Malpractice1.86
1.86 RVUs× 1.000 GPCI
Adjusted RVUs
20.1400
Conversion factor
$33.4009
Medicare rate
$672.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21181
21181 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21181
Cranial reconstruction, benign tumor contouring
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 21181
Cranial reconstruction, benign tumor contouring
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
21181 without 51 · national facility
$672.69
Cranial reconstruction, benign tumor contouring
21181-51 · Second procedure: 50%
$336.35
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%).
21181 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 61500Skull lesion excisionCraniectomy approach
- 61500 describes craniectomy for excision of a benign supratentorial tumor. Use 21181 for the distinct reconstructive contouring work associated with a benign cranial tumor.
- 62140CranioplastyDefect under 5 cm
- 62140 is cranioplasty for a skull defect up to its specified size threshold. 21181 is selected for cranial contour reconstruction associated with a benign tumor.
- 62141CranioplastyDefect over 5 cm
- 62141 addresses cranioplasty for a skull defect above the size threshold for 62140. It is not the tumor-related contouring service represented by 21181.
21181 billing questions
Is 21181 for removing the benign cranial tumor?
No. It represents reconstruction and contouring of the external cranial bone related to a benign tumor. Tumor excision is a separate surgical service when performed and should be coded based on the excision performed.
How does 21181 differ from cranioplasty codes 62140 and 62141?
21181 describes tumor-related cranial contour reconstruction. Codes 62140 and 62141 address cranioplasty for a skull defect, with the applicable code selected by the defect-size criteria.
What documentation supports reporting 21181?
The operative report should establish the benign tumor-related cranial deformity, identify the site, and describe the contouring or reconstruction performed.
Does the 90-day global period include routine postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant surgeon be reported?
Medicare pays an assistant at surgery only when the record documents medical necessity.
How are other procedures in the same operative session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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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