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Billing code 21181: Cranial reconstructionMedicare rate & RVUs

Reconstructs and contours the external cranial bone after treatment of a benign tumor when the resulting bony shape requires surgical correction.

CMS RVU26DEffective Oct 1, 2026109 payment localities34 Medicare services in 2024

Medicare pays $672.69 for 21181 nationally in a facility.

Medicare rate · 21181

Cranial reconstruction

Swap in your local Medicare rate.

Work RVUs
10.02
Total RVUs
20.14
Global days
090

National rate · 2026

$672.69

Facility setting, before claim adjustments.

See every locality for 21181 → · 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 21181 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 21181 covers

This service addresses contour deformity of the external cranial bones associated with a benign tumor, such as an irregular skull contour after tumor treatment. A craniofacial or plastic surgeon, or a neurosurgeon with reconstructive expertise, reshapes or reconstructs the affected cranial area in an operative setting. The work is directed at the bony contour rather than simply removing the tumor.

Report 21181 when the operation performs the specific cranial contour reconstruction for a benign tumor; documentation should identify the tumor-related deformity, the cranial site, and the reconstructive work performed. Tumor excision is a distinct service and should be evaluated separately when performed. Medicare assigns a 90-day global period, which includes 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 multiple procedure reduction. Assistant-at-surgery payment requires documented medical necessity.

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 21181 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

21181 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$611.25
Alaska*Unavailable$830.07
ArizonaUnavailable$655.20
ArkansasUnavailable$603.66
AtlantaUnavailable$690.60
AustinUnavailable$682.28
BakersfieldUnavailable$681.25
Baltimore/Surr. CntysUnavailable$712.91
BeaumontUnavailable$643.45
BrazoriaUnavailable$659.22

21181 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
21181 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 21181 rate is calculated

Each of 21181’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 · 21181

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.02Practice expense 8.26Malpractice 1.86

20.1400 adjusted RVUs×$33.4009 conversion factor=$672.69

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

Payment rules and modifiers for 21181

21181 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21181

Cranial 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)0Not paid without supporting documentation.
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 · 21181

Cranial 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

21181 without 51 · national facility

$672.69

Cranial reconstruction

21181-51 · Second procedure: 50%

$336.35

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

21181 compared with similar codes

Compare codes

21181 vs 61500 vs 62140 vs 62141: national Medicare rates

Swap in your local Medicare rate.

  • 21181
    Cranial reconstruction · 10.02 wRVU
    —
  • 61500
    Skull lesion excision · 18.7 wRVU
    —
  • 62140
    Cranioplasty · 14.19 wRVU
    —
  • 62141
    Cranioplasty · 15.67 wRVU
    —

How to choose

61500Skull lesion excision
61500 describes craniectomy for excision of a benign supratentorial tumor. Use 21181 for the distinct reconstructive contouring work associated with a benign cranial tumor.
62140Cranioplasty
62140 is cranioplasty for a skull defect up to its specified size threshold. 21181 is selected for cranial contour reconstruction associated with a benign tumor.
62141Cranioplasty
62141 addresses cranioplasty for a skull defect above the size threshold for 62140. It is not the tumor-related contouring service represented by 21181.

Codes related to 21181

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

Codes related to 21181
CodeHow it relatesNational office range
Same family
21182Cranial cranioplastyNeighboring cranial bone reconstruction code; confirm the operative technique and scope against its descriptor.No office rate
21183Cranial reconstructionAnother cranial bone reconstruction code in the adjacent reconstructive series.No office rate
21184Cranial reconstructionAnother code in the cranial bone reconstruction series, with a distinct operative scope.No office rate
Used instead
62140CranioplastyCranioplasty for a skull defect up to the code's size threshold, rather than tumor-related contouring.No office rate
62141CranioplastyCranioplasty for a larger skull defect, when defect repair rather than tumor contouring is performed.No office rate

21181 billing questions

Is 21181 for removing the benign cranial tumor?

No. It represents reconstruction and contouring of the external cranial bone related to a benign tumor. Tumor excision is a separate surgical service when performed and should be coded based on the excision performed.

How does 21181 differ from cranioplasty codes 62140 and 62141?

21181 describes tumor-related cranial contour reconstruction. Codes 62140 and 62141 address cranioplasty for a skull defect, with the applicable code selected by the defect-size criteria.

What documentation supports reporting 21181?

The operative report should establish the benign tumor-related cranial deformity, identify the site, and describe the contouring or reconstruction performed.

Does the 90-day global period include routine postoperative visits?

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

Can an assistant surgeon be reported?

Medicare pays an assistant at surgery only when the record documents medical necessity.

How are other procedures in the same operative session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

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 21181PPRRVU2026_Oct_nonQPP.csv, line 1,902 (RVU26D)

Open CMS sourceHow we calculate rates

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