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CPT code 21199: Mandibular reconstruction, with advancement2026 Medicare rate & RVUs

Reports reconstructive surgery that advances the lower jaw to address mandibular deformity, such as a jaw-position problem requiring operative correction.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $906.17 for 21199 nationally in a facility.

Medicare rate · 21199

Mandibular reconstruction, with advancement

Office or facility?

Work RVUs
16.31
Total RVUs
27.13
Global days
090

National rate · 2026

$906.17

Facility setting, before claim adjustments.

See every locality for 21199 →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 21199 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 21199 covers

This code describes reconstructive surgery that advances the mandible, moving the lower jaw forward as part of correcting its position or form. Oral and maxillofacial surgeons and other surgeons with craniofacial expertise typically perform the operation in a hospital or ambulatory surgical setting. Clinical contexts can include significant mandibular deficiency or deformity associated with congenital or developmental conditions; the operative plan and documented work determine whether advancement reconstruction is the service performed.

Report the code when the documented reconstruction includes advancement of the lower jaw, rather than selecting a related code solely because it involves the mandible. The operative report should identify the deformity, the advancement performed, and the reconstruction’s extent. The service has 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. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 21199 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

21199 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$836.53
AlaskaUnavailable$1,161.35
ArizonaUnavailable$886.02
ArkansasUnavailable$827.98
Atlanta, GAUnavailable$928.23
Austin, TXUnavailable$914.60
Bakersfield, CAUnavailable$912.66
Baltimore area, MDUnavailable$954.25
Beaumont, TXUnavailable$875.14
Brazoria, TXUnavailable$890.57

21199 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
21199 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 21199 rate is calculated

Each of 21199’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 · 21199

RVUs × geographic indexes × conversion factor

Office or facility?

Work16.31

16.31 RVUs× 1.000 GPCI

Practice expense8.45

8.45 RVUs× 1.000 GPCI

Malpractice2.37

2.37 RVUs× 1.000 GPCI

Adjusted RVUs

27.1300

Conversion factor

$33.4009

Medicare rate

$906.17

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

Payment rules and modifiers for 21199

21199 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21199

Mandibular reconstruction, with advancement

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 · 21199

Mandibular reconstruction, with advancement

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

21199 without 51 · national facility

$906.17

Mandibular reconstruction, with advancement

21199-51 · Second procedure: 50%

$453.09

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

21199 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21199

    Mandibular reconstruction, with advancement16.31 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 describes lower-jaw reconstruction without graft. Use 21199 when the documented reconstructive work includes advancement.
21194Mandible reconstructionWith bone graft
21194 describes lower-jaw reconstruction with graft. The advancement feature distinguishes 21199; select based on the actual operative work.
21196Mandibular reconstructionWith fixation
21196 describes lower-jaw reconstruction with fixation. Do not substitute it for 21199 when the defining documented service is advancement.

Codes related to 21199

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

Codes related to 21199
CodeHow it relatesNational office range
Same family
21193Mandibular reconstruction, without bone graftLower-jaw reconstruction without graft; distinguish it from reconstruction with advancement.No office rate
21194Mandible reconstruction, with bone graftLower-jaw reconstruction with graft; compare the documented graft work and advancement.No office rate
21195Jaw reconstruction, without fixationLower-jaw reconstruction without fixation; compare its described work with advancement reconstruction.No office rate
21196Mandibular reconstruction, with fixationLower-jaw reconstruction with fixation; distinguish the fixation-based service from advancement.No office rate
21198Jaw reconstruction, segmental lower jawReconstruction of a lower-jaw segment; compare the operative extent and technique.No office rate

21199 billing questions

How is 21199 distinguished from other lower-jaw reconstruction codes?

The key distinction is that 21199 describes reconstruction with advancement. Compare the operative work with codes describing reconstruction without graft, with graft, or with fixation.

Does modifier 50 apply when both sides of the jaw are treated?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

What postoperative care is included in the global period?

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 reported?

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

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard 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 21199PPRRVU2026_Oct_nonQPP.csv, line 1,912 (RVU26D)

Open CMS sourceHow we calculate rates

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