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Billing code 21175: Forehead reconstructionMedicare rate & RVUs

Reports bifrontal reconstruction advancing and reshaping the forehead and supraorbital rims, commonly performed to correct craniosynostosis-related craniofacial deformity.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,931.91 for 21175 nationally in a facility.

Medicare rate · 21175

Forehead reconstruction

Swap in your local Medicare rate.

Work RVUs
32.72
Total RVUs
57.84
Global days
090

National rate · 2026

$1,931.91

Facility setting, before claim adjustments.

See every locality for 21175 → · 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 21175 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 21175 covers

This major craniofacial operation reshapes and advances the frontal bone and supraorbital rims to reconstruct the lower forehead and brow region. It is commonly performed for craniosynostosis-related deformity by a craniofacial or plastic surgeon, often working with a neurosurgeon, in a hospital operating room. Bone grafting, when performed as part of the reconstruction, is included in the service.

Report the code when the operative work includes the bifrontal forehead and supraorbital rim reconstruction, rather than a more limited superolateral orbital rim procedure or forehead reconstruction alone. The operative report should identify the anatomy reconstructed, advancement performed, and any grafting. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons and team surgery are 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 21175 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

21175 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,764.28
Alaska*Unavailable$2,428.50
ArizonaUnavailable$1,882.95
ArkansasUnavailable$1,743.75
AtlantaUnavailable$1,986.18
AustinUnavailable$1,947.83
BakersfieldUnavailable$1,934.32
Baltimore/Surr. CntysUnavailable$2,043.95
BeaumontUnavailable$1,860.25
BrazoriaUnavailable$1,890.25

21175 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
21175 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 21175 rate is calculated

Each of 21175’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 · 21175

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 32.72Practice expense 19.04Malpractice 6.08

57.8400 adjusted RVUs×$33.4009 conversion factor=$1,931.91

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

Payment rules and modifiers for 21175

21175 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21175

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)0Not permitted.
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 · 21175

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

21175 without 51 · national facility

$1,931.91

Forehead reconstruction

21175-51 · Second procedure: 50%

$965.96

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

21175 compared with similar codes

Compare codes

21175 vs 21172 vs 21179 vs 21188: national Medicare rates

Swap in your local Medicare rate.

  • 21175
    Forehead reconstruction · 32.72 wRVU
    —
  • 21172
    Forehead reconstruction · 27.5 wRVU
    —
  • 21179
    Forehead reconstruction · 22.08 wRVU
    —
  • 21188
    Midface reconstruction · 22.57 wRVU
    —

How to choose

21172Forehead reconstruction
Choose 21175 for bifrontal forehead and supraorbital rim reconstruction with advancement. Code 21172 describes reconstruction focused on the superolateral orbital rim and lower forehead.
21179Forehead reconstruction
Code 21179 addresses forehead reconstruction with grafts; use 21175 when the operative work includes bifrontal advancement and reconstruction of the supraorbital rims.
21188Midface reconstruction
Code 21188 addresses reconstruction centered on the midface. Code 21175 is for reconstruction of the forehead and supraorbital rims.

Codes related to 21175

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

Codes related to 21175
CodeHow it relatesNational office range
Same family
21172Forehead reconstructionRelated forehead and orbital rim reconstruction focused on the superolateral orbital rim and lower forehead.No office rate
Used instead
21179Forehead reconstructionForehead reconstruction with grafts when the work does not include this bifrontal orbital rim advancement.No office rate
21180Forehead reconstructionForehead reconstruction using autograft for a different reconstructive approach.No office rate
21188Midface reconstructionMidface reconstruction for deformity centered on the midface rather than the forehead and supraorbital rims.No office rate

21175 billing questions

How does this differ from 21172?

This code describes bifrontal reconstruction of the forehead and supraorbital rims. Code 21172 is the related, more limited reconstruction of the superolateral orbital rim and lower forehead.

Can bone grafting be reported separately?

Bone grafting performed as part of this reconstruction is included in the service. The operative report should document the reconstruction and any grafting performed.

Should modifier 50 be added for both sides?

No. The anatomy and descriptor make modifier 50 inappropriate for this code.

What postoperative care is included?

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?

An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code under the CMS facts provided.

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 21175PPRRVU2026_Oct_nonQPP.csv, line 1,899 (RVU26D)

Open CMS sourceHow we calculate rates

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