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Billing code 21139: Forehead reconstructionMedicare rate & RVUs

Reports forehead reconstruction that combines brow contouring with setback of the frontal bone, commonly performed for craniofacial or gender-affirming facial surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities17 Medicare services in 2024

Medicare pays $984.32 for 21139 nationally in a facility.

Medicare rate · 21139

Forehead reconstruction

Swap in your local Medicare rate.

Work RVUs
14.64
Total RVUs
29.47
Global days
090

National rate · 2026

$984.32

Facility setting, before claim adjustments.

See every locality for 21139 → · 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 21139 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 21139 covers

This operation reshapes the forehead and brow and sets back the frontal bone to change the forehead’s projection. It is performed by craniofacial or plastic surgeons, often as part of facial feminization surgery or reconstruction for a craniofacial deformity. The operative work may involve exposing and reshaping the bone, repositioning it, and securing it in the planned contour. The setting is typically a hospital operating room.

Select this code when the documented procedure includes both contouring and bone setback; contouring alone or a prosthetic approach has a different code in this family. The operative report should describe the bone work, setback, and brow contouring performed. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 21139 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

21139 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$894.33
Alaska*Unavailable$1,214.32
ArizonaUnavailable$958.70
ArkansasUnavailable$883.23
AtlantaUnavailable$1,010.52
AustinUnavailable$998.41
BakersfieldUnavailable$996.92
Baltimore/Surr. CntysUnavailable$1,043.21
BeaumontUnavailable$941.47
BrazoriaUnavailable$964.61

21139 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.

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View every state and territory as a table
21139 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 21139 rate is calculated

Each of 21139’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 · 21139

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.64Practice expense 12.11Malpractice 2.72

29.4700 adjusted RVUs×$33.4009 conversion factor=$984.32

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 21139

21139 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21139

Forehead reconstruction

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 · 21139

Forehead reconstruction

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

21139 without 51 · national facility

$984.32

Forehead reconstruction

21139-51 · Second procedure: 50%

$492.16

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

21139 compared with similar codes

Compare codes

21139 vs 21137 vs 21138 vs 21172 vs 21175: national Medicare rates

Swap in your local Medicare rate.

  • 21139
    Forehead reconstruction · 14.64 wRVU
    —
  • 21137
    Forehead reduction · 9.98 wRVU
    —
  • 21138
    Forehead reduction · 12.55 wRVU
    —
  • 21172
    Forehead reconstruction · 27.5 wRVU
    —
  • 21175
    Forehead reconstruction · 32.72 wRVU
    —

How to choose

21137Forehead reduction
21137 is the contouring-only option. Report 21139 when frontal bone setback is also performed.
21138Forehead reduction
21138 describes forehead contouring with a prosthetic approach; 21139 describes contouring with bone setback.
21172Forehead reconstruction
21172 is a related supraorbital and lower-forehead reconstruction option. Distinguish it from 21139 by the operative anatomy and work documented.
21175Forehead reconstruction
21175 addresses reconstruction involving the supraorbital rim and lower forehead. Use 21139 for the documented forehead contouring and setback procedure.

Codes related to 21139

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

Codes related to 21139
CodeHow it relatesNational office range
Same family
21137Forehead reductionForehead contouring without the setback described for 21139.No office rate
21138Forehead reductionForehead contouring using a prosthetic approach rather than the setback procedure.No office rate
Used instead
21172Forehead reconstructionRelated forehead and supraorbital reconstruction code; distinguish by the documented anatomy and operative work.No office rate
21175Forehead reconstructionRelated reconstruction involving the supraorbital rim and lower forehead; select for the documented extent.No office rate

21139 billing questions

How does 21139 differ from 21137?

21139 is for forehead contouring that also includes setback of the frontal bone. Use 21137 when the documented work is forehead contouring without setback.

How does 21139 differ from 21138?

21138 describes forehead contouring with a prosthetic approach. 21139 describes contouring with bone setback; select based on the work documented in the operative report.

Can modifier 50 be reported?

No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate for its descriptor and anatomy.

What postoperative care is included?

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

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 documentation supports reporting 21139?

The operative report should identify the forehead and brow work and document frontal bone setback, distinguishing it from contouring alone or a prosthetic approach.

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 21139PPRRVU2026_Oct_nonQPP.csv, line 1,885 (RVU26D)

Open CMS sourceHow we calculate rates

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