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CPT 21159: Midface reconstructionMedicare rate & RVUs

Reports LeFort III midface reconstruction with advancement and no bone graft, commonly performed to correct severe midface retrusion in craniofacial conditions.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,210.14 for 21159 nationally in a facility.

Medicare rate · 21159

Midface reconstruction

Swap in your local Medicare rate.

Work RVUs
42.06
Total RVUs
66.17
Global days
090

National rate · 2026

$2,210.14

Facility setting, before claim adjustments.

See every locality for 21159 →

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 21159 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 21159 covers

This operation mobilizes and advances the midface at the LeFort III level without a bone graft. Craniofacial, oral and maxillofacial, or plastic surgeons may perform it for substantial midface retrusion, including deformity associated with syndromic craniosynostosis. It is a major reconstructive procedure generally performed in a hospital operating room.

Select this code when the operative report supports LeFort III reconstruction with advancement and documents that no bone graft was used. Distinguish it from the non-advancement LeFort III codes and from the advancement code that includes grafting. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. 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 21159 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

21159 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,046.00
Alaska*Unavailable$2,859.32
ArizonaUnavailable$2,161.96
ArkansasUnavailable$2,025.93
AtlantaUnavailable$2,265.24
AustinUnavailable$2,224.32
BakersfieldUnavailable$2,214.10
Baltimore/Surr. CntysUnavailable$2,325.09
BeaumontUnavailable$2,141.56
BrazoriaUnavailable$2,170.79

21159 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
21159 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 21159 rate is calculated

Each of 21159’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 · 21159

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 42.06Practice expense 17.96Malpractice 6.15

66.1700 adjusted RVUs×$33.4009 conversion factor=$2,210.14

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

Payment rules and modifiers for 21159

21159 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21159

Midface 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 · 21159

Midface 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

21159 without 51 · national facility

$2,210.14

Midface reconstruction

21159-51 · Second procedure: 50%

$1,105.07

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

21159 compared with similar codes

Compare codes

21159 vs 21154 vs 21155 vs 21160: national Medicare rates

Swap in your local Medicare rate.

  • 21159
    Midface reconstruction · 42.06 wRVU
    —
  • 21154
    Midface reconstruction · 30.51 wRVU
    —
  • 21155
    Midface reconstruction · 34.34 wRVU
    —
  • 21160
    Midface reconstruction · 46.01 wRVU
    —

How to choose

21154Midface reconstruction
Choose 21159 for LeFort III advancement without a bone graft. Code 21154 describes LeFort III reconstruction without the advancement distinction and without grafting.
21155Midface reconstruction
Code 21155 describes LeFort III reconstruction with a bone graft but without the advancement distinction. For advancement with a graft, use 21160 instead.
21160Midface reconstruction
Both codes describe LeFort III advancement; 21159 is the no-graft version, while 21160 includes bone grafting.

Codes related to 21159

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

Codes related to 21159
CodeHow it relatesNational office range
Same family
21160Midface reconstructionLeFort III advancement counterpart when a bone graft is used.No office rate
21154Midface reconstructionLeFort III reconstruction without the advancement distinction or bone graft.No office rate
21155Midface reconstructionLeFort III reconstruction with bone graft, without the advancement distinction.No office rate
Used instead
21188Midface reconstructionA separate midface reconstruction code for a different reconstructive approach.No office rate

21159 billing questions

How does 21159 differ from 21154?

21159 describes LeFort III reconstruction with advancement and no bone graft. 21154 is the LeFort III reconstruction code without the advancement distinction.

When should 21160 be reported instead?

Use 21160 when the LeFort III advancement includes a bone graft. The operative report should establish whether a graft was used.

Can modifier 50 be used for bilateral work?

No. Modifier 50 is inappropriate for this code; the descriptor and anatomy do not support bilateral adjustment.

Is an assistant at surgery payable?

CMS permits assistant-at-surgery payment for this procedure. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.

What postoperative care is included?

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

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in the same session 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 21159PPRRVU2026_Oct_nonQPP.csv, line 1,896 (RVU26D)

Open CMS sourceHow we calculate rates

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