Billing code 21142: Le Fort I reconstructionMedicare rate & RVUs

Medicare pays $1,238.17 for 21142 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 21142 covers

This operation reconstructs the midface by mobilizing the maxilla with a Le Fort I osteotomy, dividing it into two segments, and repositioning the segments to address a skeletal deformity or related bite problem. An oral and maxillofacial surgeon or another surgeon trained in craniofacial reconstruction typically performs it in an operating room, often as part of corrective jaw surgery.

Select this code when the operative report supports a two-piece maxillary reconstruction and the procedure is performed without bone grafting. The report should identify the osteotomy, number of resulting segments, repositioning, and any grafting. When bone grafting is part of the procedure, compare the two-piece with-graft code, 21146. 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 50% 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 21142 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

21142 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 21142 rate is calculated

Each of 21142’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.

Payment rules and modifiers for 21142

21142 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

21142 compared with similar codes

How to choose

21141Le Fort I reconstruction

Use 21141 when the maxilla is reconstructed as one piece; use 21142 when the operative report documents two pieces.

21143LeFort I reconstruction

Use 21143 for three or more pieces. The distinction from 21142 is the number of maxillary segments, not the number of separate procedures.

21146Midface reconstruction

Both represent two-piece Le Fort I reconstruction; 21146 is the with-bone-graft code, while 21142 is without bone graft.

Codes related to 21142

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

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

Open CMS sourceHow we calculate rates