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Billing code 21049: Maxillary cyst excisionMedicare rate & RVUs

Reports removal of a maxillary cyst or benign lesion when the extent requires an extraoral approach, partial maxillary resection, and repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities197 Medicare services in 2024

Medicare pays $1,021.07 for 21049 nationally in a facility.

Medicare rate · 21049

Maxillary cyst excision

Work RVUs
18.84
Total RVUs
30.57
Global days
090

National rate · 2026

$1,021.07

Facility setting, before claim adjustments.

See every locality for 21049 →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.

On this page 10 sections
  1. Medicare rate
  2. What 21049 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 21049 covers

This service addresses a benign cyst or lesion of the upper jaw that requires an extraoral surgical approach and removal of part of the maxilla, with repair of the resulting defect. An oral and maxillofacial surgeon or another surgeon experienced in maxillary surgery may perform it in an operating room. The operative report should identify the maxillary lesion, the extraoral approach, the bone removed, and the repair performed.

Select this code for the documented extent of maxillary excision and repair, rather than a less extensive removal or a procedure on the mandible. It 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 50% multiple-procedure reduction. Bilateral adjustment is inappropriate. 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 21049 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

21049 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$946.70
Alaska*Unavailable$1,318.94
ArizonaUnavailable$999.64
ArkansasUnavailable$937.56
AtlantaUnavailable$1,044.42
AustinUnavailable$1,030.92
BakersfieldUnavailable$1,030.62
Baltimore/Surr. CntysUnavailable$1,073.21
BeaumontUnavailable$987.37
BrazoriaUnavailable$1,005.24

21049 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
21049 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 21049 rate is calculated

Each of 21049’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 · 21049

RVUs × geographic indexes × conversion factor

Work18.84

18.84 RVUs× 1.000 GPCI

Practice expense9.27

9.27 RVUs× 1.000 GPCI

Malpractice2.46

2.46 RVUs× 1.000 GPCI

Adjusted RVUs

30.5700

Conversion factor

$33.4009

Medicare rate

$1,021.07

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

Payment rules and modifiers for 21049

21049 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21049

Maxillary cyst excision

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 · 21049

Maxillary cyst excision

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

21049 without 51 · national facility

$1,021.07

Maxillary cyst excision

21049-51 · Second procedure: 50%

$510.54

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

21049 compared with similar codes

Compare codes · National

5 codes, side by side

  • 21049

    Maxillary cyst excision18.84 wRVU

    Not priced

  • 21048

    Maxillary excision14.34 wRVU

    Not priced

  • 21030

    Bone lesion excision4.79 wRVU

    $475.96

  • 21047

    Jaw cyst excision19.57 wRVU

    Not priced

  • 21034

    Tumor excision16.95 wRVU

    $1,305.64

How to choose

21048Maxillary excision
21048 is for a maxillary benign cyst or lesion excision requiring an intraoral osteotomy. Choose 21049 when the operative extent requires an extraoral approach, partial maxillary resection, and repair.
21030Bone lesion excision
21030 describes maxillary benign cyst or tumor removal by enucleation and curettage. It is not the choice for the more extensive maxillary resection and repair represented by 21049.
21047Jaw cyst excision
21047 concerns an extensive benign cyst or tumor excision of the mandible. 21049 is for the corresponding upper-jaw site.
21034Tumor excision
21034 is for a malignant tumor of the maxilla or zygoma. 21049 is for a benign cyst or lesion requiring extensive maxillary removal and repair.

Codes related to 21049

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

Codes related to 21049
CodeHow it relatesNational office range
Same family
21048Maxillary excisionMaxillary benign-lesion excision requiring an intraoral osteotomy rather than the more extensive extraoral approach.No office rate
21047Jaw cyst excisionCorresponding extensive benign cyst or tumor excision for the mandible rather than the maxilla.No office rate
21046Mandibular lesion excisionExtensive benign cyst or tumor excision involving the mandible, not the upper jaw.No office rate
Used instead
21030Bone lesion excisionFor maxillary benign cyst or tumor removal by enucleation and curettage when the extensive resection and repair are not required.$424.63–$615.37
21034Tumor excisionFor malignant tumor excision involving the maxilla or zygoma rather than a benign cyst or lesion.$1,172.65–$1,619.12

21049 billing questions

How does this differ from 21048?

Use 21049 when the documented maxillary excision requires an extraoral approach, partial maxillary resection, and repair. 21048 describes a less extensive maxillary cyst or benign-lesion excision requiring an intraoral osteotomy.

Can the cyst removal and repair be reported separately?

The repair is part of the service described by this code. The operative documentation should show the lesion removal, extent of bone resection, and repair.

Should modifier 50 be appended for bilateral disease?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

How does the 90-day global period affect follow-up visits?

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.

What happens when 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 21049PPRRVU2026_Oct_nonQPP.csv, line 1,856 (RVU26D)

Open CMS sourceHow we calculate rates

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