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CPT code 21188: Midface reconstruction2026 Medicare rate & RVUs

Midface reconstruction covers major surgical reconstruction of the central facial skeleton, reported when the operative plan and documented work support this specific procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,428.89 for 21188 nationally in a facility.

Medicare rate · 21188

Midface reconstruction

Office or facility?

Work RVUs
22.57
Total RVUs
42.78
Global days
090

National rate · 2026

$1,428.89

Facility setting, before claim adjustments.

See every locality for 21188 →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 21188 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 21188 covers

This major reconstructive operation addresses the bony framework of the midface, such as the maxillary and cheek-region structures. It may be performed for a congenital craniofacial deformity, significant facial trauma, or a defect after removal of diseased tissue. Craniofacial, oral and maxillofacial, and plastic surgeons commonly perform this work in an operating room. The operative report should identify the reconstructed anatomy and describe the surgical approach and any grafting or other reconstruction performed.

Report 21188 when the documented midface reconstruction matches this procedure rather than a separately defined LeFort reconstruction or a lower-jaw procedure. The 90-day global period 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. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be allowed; 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 21188 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

21188 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,310.76
AlaskaUnavailable$1,793.56
ArizonaUnavailable$1,395.62
ArkansasUnavailable$1,296.14
Atlanta, GAUnavailable$1,462.16
Austin, TXUnavailable$1,450.76
Bakersfield, CAUnavailable$1,454.83
Baltimore area, MDUnavailable$1,508.14
Beaumont, TXUnavailable$1,370.21
Brazoria, TXUnavailable$1,405.80

21188 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
21188 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 21188 rate is calculated

Each of 21188’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 · 21188

RVUs × geographic indexes × conversion factor

Office or facility?

Work22.57

22.57 RVUs× 1.000 GPCI

Practice expense16.94

16.94 RVUs× 1.000 GPCI

Malpractice3.27

3.27 RVUs× 1.000 GPCI

Adjusted RVUs

42.7800

Conversion factor

$33.4009

Medicare rate

$1,428.89

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

Payment rules and modifiers for 21188

21188 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21188

Midface reconstruction

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 · 21188

Midface reconstruction

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

21188 without 51 · national facility

$1,428.89

Midface reconstruction

21188-51 · Second procedure: 50%

$714.45

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

21188 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21188

    Midface reconstruction22.57 wRVU

    Not priced

  • 21154

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

    Not priced

  • 21155

    Midface reconstruction, leFort III, with interpositional graft34.34 wRVU

    Not priced

  • 21193

    Mandibular reconstruction, without bone graft18.43 wRVU

    Not priced

How to choose

21154Midface reconstructionLe Fort III, no interpositional graft
21154 identifies a LeFort III reconstruction without a LeFort I procedure. Select between it and 21188 by matching the documented operation to the specific code definition.
21155Midface reconstructionLeFort III, with interpositional graft
21155 identifies a LeFort III reconstruction with a LeFort I procedure. The operative report should establish whether that defined combination was performed.
21193Mandibular reconstructionWithout bone graft
21193 is for lower-jaw reconstruction without graft; 21188 concerns the midface. The reconstructed bone site determines which code family to consider.

Codes related to 21188

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

Codes related to 21188
CodeHow it relatesNational office range
Same family
21154Midface reconstruction, le Fort III, no interpositional graftA LeFort III midface reconstruction option specified without a LeFort I procedure.No office rate
21155Midface reconstruction, leFort III, with interpositional graftA LeFort III midface reconstruction option specified with a LeFort I procedure.No office rate
21159Midface reconstruction, leFort III advancement, no graftA LeFort III advancement reconstruction option without bone graft.No office rate
21160Midface reconstruction, leFort III advancement with graftA LeFort III advancement reconstruction option with bone graft.No office rate
Used instead
21193Mandibular reconstruction, without bone graftReconstructs the lower jaw rather than the midface.No office rate

21188 billing questions

How should 21188 be distinguished from the LeFort reconstruction codes?

Use the code whose defined procedure matches the operative work. The LeFort codes identify specific LeFort levels and, in some cases, grafting or advancement details; the operative report must support the selected procedure.

Can modifier 50 be appended for reconstruction on both sides?

No. CMS identifies bilateral adjustment as inappropriate for 21188, so modifier 50 is not the right way to report bilateral work.

What postoperative care is included?

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

Can an assistant surgeon be reported?

Assistant-at-surgery payment may be allowed for 21188. Co-surgeons and team surgery are not permitted.

How is 21188 paid when another procedure is performed in the same session?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% 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
RVUs for 21188PPRRVU2026_Oct_nonQPP.csv, line 1,906 (RVU26D)

Open CMS sourceHow we calculate rates

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