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CPT code 21198: Jaw reconstruction, segmental lower jaw2026 Medicare rate & RVUs

Reports surgical reconstruction of a segment of the lower jaw, such as when a mandibular defect requires segment-focused repair rather than jaw advancement.

CMS RVU26DEffective Oct 1, 2026109 payment localities413 Medicare services in 2024

Medicare pays $908.84 for 21198 nationally in a facility.

Medicare rate · 21198

Jaw reconstruction, segmental lower jaw

Office or facility?

Work RVUs
15.32
Total RVUs
27.21
Global days
090

National rate · 2026

$908.84

Facility setting, before claim adjustments.

See every locality for 21198 →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 21198 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 21198 covers

This operation reconstructs a segment of the mandible to restore jaw continuity or contour. Oral and maxillofacial surgeons and other reconstructive surgeons may perform it in a hospital operating room for a defect related to trauma, tumor removal, or another condition requiring segmental repair. The operative report should identify the mandibular segment reconstructed and describe the work performed; the code is not selected merely because the procedure involves the lower jaw.

Report the code when the documented operation is segmental mandibular reconstruction, distinguishing it from the separate lower-jaw reconstruction approaches represented by 21193–21196 and from advancement under 21199. The procedure has 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 other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 21198 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

21198 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$838.45
AlaskaUnavailable$1,156.00
ArizonaUnavailable$888.94
ArkansasUnavailable$829.75
Atlanta, GAUnavailable$929.15
Austin, TXUnavailable$921.35
Bakersfield, CAUnavailable$923.99
Baltimore area, MDUnavailable$957.03
Beaumont, TXUnavailable$874.37
Brazoria, TXUnavailable$895.19

21198 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
21198 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 21198 rate is calculated

Each of 21198’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 · 21198

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.32

15.32 RVUs× 1.000 GPCI

Practice expense9.88

9.88 RVUs× 1.000 GPCI

Malpractice2.01

2.01 RVUs× 1.000 GPCI

Adjusted RVUs

27.2100

Conversion factor

$33.4009

Medicare rate

$908.84

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

Payment rules and modifiers for 21198

21198 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21198

Jaw reconstruction, segmental lower jaw

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)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 · 21198

Jaw reconstruction, segmental lower jaw

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

21198 without 51 · national facility

$908.84

Jaw reconstruction, segmental lower jaw

21198-51 · Second procedure: 50%

$454.42

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

21198 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21198

    Jaw reconstruction, segmental lower jaw15.32 wRVU

    Not priced

  • 21193

    Mandibular reconstruction, without bone graft18.43 wRVU

    Not priced

  • 21194

    Mandible reconstruction, with bone graft21.27 wRVU

    Not priced

  • 21199

    Mandibular reconstruction, with advancement16.31 wRVU

    Not priced

How to choose

21193Mandibular reconstructionWithout bone graft
21193 describes lower-jaw reconstruction without bone graft. Use 21198 when the operation is documented as segmental reconstruction, rather than selecting by graft status alone.
21194Mandible reconstructionWith bone graft
21194 describes lower-jaw reconstruction with bone graft. The defining distinction for 21198 is segmental reconstruction; confirm the operative approach rather than relying only on whether a graft was used.
21199Mandibular reconstructionWith advancement
21199 is for lower-jaw reconstruction with advancement. 21198 is the segmental reconstruction option, not the advancement approach.

Codes related to 21198

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

Codes related to 21198
CodeHow it relatesNational office range
Same family
21193Mandibular reconstruction, without bone graftA distinct lower-jaw reconstruction option; its descriptor specifies reconstruction without bone graft.No office rate
21194Mandible reconstruction, with bone graftA distinct lower-jaw reconstruction option; its descriptor specifies reconstruction with bone graft.No office rate
21195Jaw reconstruction, without fixationAnother lower-jaw reconstruction option, distinguished in its descriptor by fixation.No office rate
21196Mandibular reconstruction, with fixationAnother lower-jaw reconstruction option, distinguished in its descriptor by fixation.No office rate
Used instead
21199Mandibular reconstruction, with advancementFor lower-jaw reconstruction with advancement rather than the segmental reconstruction represented here.No office rate

21198 billing questions

How is 21198 distinguished from 21193–21196?

Use the operative description to determine whether the surgeon performed segmental mandibular reconstruction or one of the distinct lower-jaw reconstruction approaches represented by 21193–21196. Do not choose based only on the fact that the mandible was operated on.

When is 21199 a better fit?

21199 describes lower-jaw reconstruction with advancement. Choose 21198 when the documented procedure is segmental reconstruction rather than reconstruction by advancement.

What documentation supports reporting 21198?

Document the mandibular segment reconstructed, the defect or clinical reason for reconstruction, and the operative steps that establish segmental reconstruction. The note should make the distinction from other lower-jaw reconstruction approaches clear.

How does the global period affect postoperative billing?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical episode.

Can an assistant or co-surgeon be reported?

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

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

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed during 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

Show the CMS file lines behind this rate
RVUs for 21198PPRRVU2026_Oct_nonQPP.csv, line 1,911 (RVU26D)

Open CMS sourceHow we calculate rates

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