FeeBase
Log inGet started
Menu

CPT code 21195: Jaw reconstruction, without fixation2026 Medicare rate & RVUs

Reconstructive surgery of the lower jaw without fixation is reported when the operative work rebuilds the mandible without fixation.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,217.46 for 21195 nationally in a facility.

Medicare rate · 21195

Jaw reconstruction, without fixation

Office or facility?

Work RVUs
18.68
Total RVUs
36.45
Global days
090

National rate · 2026

$1,217.46

Facility setting, before claim adjustments.

See every locality for 21195 →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 21195 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 21195 covers

This code describes reconstructive surgery of the mandible, the lower jaw, performed without fixation. Oral and maxillofacial surgeons and other surgeons who perform craniofacial reconstruction may use it for operative repair of a mandibular defect or deformity. The operative report should make clear that the work reconstructs the lower jaw and that fixation is not part of the reported service; routine dental treatment or a procedure limited to another facial bone is not this service.

Report the code when the documented reconstruction matches these features. 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 50% multiple-procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. 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 21195 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

21195 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,115.30
AlaskaUnavailable$1,521.48
ArizonaUnavailable$1,188.83
ArkansasUnavailable$1,102.64
Atlanta, GAUnavailable$1,245.58
Austin, TXUnavailable$1,237.57
Bakersfield, CAUnavailable$1,242.22
Baltimore area, MDUnavailable$1,285.62
Beaumont, TXUnavailable$1,165.76
Brazoria, TXUnavailable$1,198.01

21195 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
21195 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 21195 rate is calculated

Each of 21195’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 · 21195

RVUs × geographic indexes × conversion factor

Office or facility?

Work18.68

18.68 RVUs× 1.000 GPCI

Practice expense15.06

15.06 RVUs× 1.000 GPCI

Malpractice2.71

2.71 RVUs× 1.000 GPCI

Adjusted RVUs

36.4500

Conversion factor

$33.4009

Medicare rate

$1,217.46

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

Payment rules and modifiers for 21195

21195 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21195

Jaw reconstruction, without fixation

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)2Already bilateral by definition: paid once at 100%.
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 · 21195

Jaw reconstruction, without fixation

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

21195 without 51 · national facility

$1,217.46

Jaw reconstruction, without fixation

21195-51 · Second procedure: 50%

$608.73

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

21195 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21195

    Jaw reconstruction, without fixation18.68 wRVU

    Not priced

  • 21193

    Mandibular reconstruction, without bone graft18.43 wRVU

    Not priced

  • 21194

    Mandible reconstruction, with bone graft21.27 wRVU

    Not priced

  • 21196

    Mandibular reconstruction, with fixation20.31 wRVU

    Not priced

How to choose

21193Mandibular reconstructionWithout bone graft
21193 identifies lower-jaw reconstruction without a graft. Use 21195 when the documented distinction is reconstruction without fixation.
21194Mandible reconstructionWith bone graft
21194 identifies lower-jaw reconstruction with a graft. Use 21195 when the documented distinction is reconstruction without fixation.
21196Mandibular reconstructionWith fixation
21196 is the neighboring fixation option. The operative report should distinguish reconstruction performed with fixation from reconstruction without it.

Codes related to 21195

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

Codes related to 21195
CodeHow it relatesNational office range
Used instead
21193Mandibular reconstruction, without bone graftRelated lower-jaw reconstruction option distinguished by graft use.No office rate
21194Mandible reconstruction, with bone graftRelated lower-jaw reconstruction option distinguished by graft use.No office rate
21196Mandibular reconstruction, with fixationAdjacent lower-jaw reconstruction option that includes fixation.No office rate
21198Jaw reconstruction, segmental lower jawReconstructs a lower-jaw segment; compare the documented extent and technique.No office rate
21199Mandibular reconstruction, with advancementLower-jaw reconstruction involving advancement is a different operative circumstance.No office rate

21195 billing questions

How does this differ from 21193 or 21194?

Those neighboring codes distinguish lower-jaw reconstruction by graft use: 21193 without a graft and 21194 with a graft. Choose based on the documented procedure and the code descriptor that matches it.

Can modifier 50 be used for bilateral work?

The code is already priced as bilateral, so modifier 50 does not increase payment.

Can an assistant surgeon be reported?

CMS allows payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.

What postoperative care is included?

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

What happens if another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% 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
RVUs for 21195PPRRVU2026_Oct_nonQPP.csv, line 1,909 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 21195 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 21195 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist