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CPT code 21196: Mandibular reconstruction, with fixation2026 Medicare rate & RVUs

Reports reconstruction of the mandibular rami, body, or angle when fixation is used to stabilize the reconstructed jaw.

CMS RVU26DEffective Oct 1, 2026109 payment localities75 Medicare services in 2024

Medicare pays $1,296.62 for 21196 nationally in a facility.

Medicare rate · 21196

Mandibular reconstruction, with fixation

Office or facility?

Work RVUs
20.31
Total RVUs
38.82
Global days
090

National rate · 2026

$1,296.62

Facility setting, before claim adjustments.

See every locality for 21196 →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 21196 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 21196 covers

Code 21196 represents operative reconstruction of the mandibular rami, body, or angle with fixation to stabilize the reconstructed jaw. Oral and maxillofacial, plastic, or craniofacial surgeons may perform the procedure in a hospital or ambulatory surgery setting to address mandibular defects or deformity after trauma, tumor removal, or a congenital condition. The operative report should identify the reconstructed area, the clinical reason for reconstruction, the technique, and the fixation used; document grafting when relevant to choosing among mandibular reconstruction codes.

CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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 21196 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

21196 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,188.90
AlaskaUnavailable$1,625.35
ArizonaUnavailable$1,266.32
ArkansasUnavailable$1,175.55
Atlanta, GAUnavailable$1,326.78
Austin, TXUnavailable$1,316.89
Bakersfield, CAUnavailable$1,320.88
Baltimore area, MDUnavailable$1,368.77
Beaumont, TXUnavailable$1,242.85
Brazoria, TXUnavailable$1,275.70

21196 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
21196 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 21196 rate is calculated

Each of 21196’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 · 21196

RVUs × geographic indexes × conversion factor

Office or facility?

Work20.31

20.31 RVUs× 1.000 GPCI

Practice expense15.56

15.56 RVUs× 1.000 GPCI

Malpractice2.95

2.95 RVUs× 1.000 GPCI

Adjusted RVUs

38.8200

Conversion factor

$33.4009

Medicare rate

$1,296.62

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

Payment rules and modifiers for 21196

21196 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21196

Mandibular reconstruction, with 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)1Permitted with supporting documentation.
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 · 21196

Mandibular reconstruction, with 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

21196 without 51 · national facility

$1,296.62

Mandibular reconstruction, with fixation

21196-51 · Second procedure: 50%

$648.31

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

21196 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21196

    Mandibular reconstruction, with fixation20.31 wRVU

    Not priced

  • 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

How to choose

21195Jaw reconstructionWithout fixation
Use 21196 when fixation is part of the documented reconstruction; 21195 describes the corresponding reconstruction without fixation.
21193Mandibular reconstructionWithout bone graft
21193 is the mandibular reconstruction variant specified without bone graft. Distinguish it from 21196 using the documented procedure and applicable descriptor.
21194Mandible reconstructionWith bone graft
21194 is the mandibular reconstruction variant specified with bone graft. Do not infer graft use solely from fixation documented for 21196.

Codes related to 21196

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

Codes related to 21196
CodeHow it relatesNational office range
Same family
21195Jaw reconstruction, without fixationReconstruction of the mandibular rami, body, or angle without fixation.No office rate
21193Mandibular reconstruction, without bone graftMandibular reconstruction variant specified without bone graft.No office rate
21194Mandible reconstruction, with bone graftMandibular reconstruction variant specified with bone graft.No office rate

21196 billing questions

How does 21196 differ from 21195?

Both describe reconstruction of the mandibular rami, body, or angle. Code 21196 is the fixation variant; 21195 describes reconstruction without fixation.

Does fixation alone distinguish 21196 from 21193 or 21194?

Codes 21193 and 21194 distinguish reconstruction without or with a bone graft, respectively. Choose based on the documented procedure and applicable descriptor, rather than assuming fixation establishes graft use.

Should modifier 50 be added for bilateral reconstruction?

CMS prices 21196 as bilateral, and modifier 50 does not increase payment.

What documentation supports reporting 21196?

Document the mandibular area reconstructed, the indication, the reconstructive technique, and the fixation used. Record grafting when performed and relevant to code selection.

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 or co-surgeon be paid?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.

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 21196PPRRVU2026_Oct_nonQPP.csv, line 1,910 (RVU26D)

Open CMS sourceHow we calculate rates

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