Billing code 21208: Bone augmentationMedicare rate & RVUs
Surgical augmentation of facial bone contour is reported when a surgeon adds structural support or projection to deficient facial skeletal areas.
Medicare pays $1,657.02 for 21208 nationally in the office and $670.69 in a hospital or facility. Local office rates run $1,460.74–$2,226.36.
Medicare rate · 21208
Bone augmentation
Swap in your local Medicare rate.
- Work RVUs
- 11.13
- Total RVUs
- 49.61
- Global days
- 090
National rate · 2026
$1,657.02
Office setting, before claim adjustments.
See every locality for 21208 → · 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
What 21208 covers
This operation increases projection or support in an underdeveloped or deficient facial bone area. A surgeon may use an implant or graft material to augment the facial skeleton; the operative record should identify the treated site and the method used. Oral and maxillofacial, plastic, and craniofacial surgeons may perform the procedure in an operating room or another appropriate surgical setting.
Report the code for the facial-bone augmentation itself, not for reduction or a distinct reconstructive service. Document the anatomic site, the deficiency being treated, and the augmentation performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 21208 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1460.74 to $2226.36
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,482.84 | $619.80 |
| Alaska* | $1,903.95 | $853.51 |
| Arizona | $1,612.23 | $656.48 |
| Arkansas | $1,460.74 | $613.49 |
| Atlanta | $1,686.79 | $684.68 |
| Austin | $1,724.78 | $681.25 |
| Bakersfield | $1,766.16 | $685.14 |
| Baltimore/Surr. Cntys | $1,763.97 | $705.64 |
| Beaumont | $1,542.18 | $644.62 |
| Brazoria | $1,639.19 | $661.74 |
| Chicago | $1,722.49 | $731.23 |
| Chico | $1,762.22 | $681.21 |
| Colorado | $1,731.35 | $681.90 |
| Connecticut | $1,769.24 | $706.96 |
| Dallas | $1,649.19 | $666.80 |
| Dc + Md/Va Suburbs | $1,903.03 | $741.13 |
| Delaware | $1,639.56 | $665.07 |
| Detroit | $1,643.58 | $691.77 |
| East St. Louis | $1,602.07 | $694.64 |
| El Centro | $1,762.44 | $681.42 |
| Fort Lauderdale | $1,708.51 | $709.36 |
| Fort Worth | $1,637.34 | $664.82 |
| Fresno | $1,762.22 | $681.21 |
| Galveston | $1,643.78 | $664.35 |
| Hanford-Corcoran | $1,762.22 | $681.21 |
| Hawaii, Guam | $1,808.68 | $687.23 |
| Houston | $1,667.75 | $688.33 |
| Idaho | $1,534.64 | $627.22 |
| Indiana | $1,543.90 | $629.57 |
| Iowa | $1,525.11 | $622.62 |
| Kansas | $1,516.13 | $624.49 |
| Kentucky | $1,515.49 | $638.65 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $1,884.76 | $717.93 |
| Madera | $1,762.22 | $681.21 |
| Manhattan | $1,907.58 | $761.46 |
| Merced | $1,762.22 | $681.21 |
| Metropolitan Boston | $1,908.30 | $730.62 |
| Metropolitan Kansas City | $1,580.28 | $654.12 |
| Metropolitan Philadelphia | $1,723.06 | $696.29 |
| Metropolitan St. Louis | $1,597.51 | $658.53 |
| Miami | $1,774.82 | $748.05 |
| Minnesota | $1,662.22 | $647.29 |
| Mississippi | $1,473.03 | $623.80 |
| Modesto | $1,762.22 | $681.21 |
| Montana** | $1,656.93 | $670.60 |
| Napa | $2,053.71 | $753.73 |
| Nebraska | $1,534.21 | $623.83 |
| Nevada** | $1,650.95 | $663.64 |
| New Hampshire | $1,702.45 | $675.68 |
| New Mexico | $1,562.77 | $658.30 |
| New Orleans | $1,589.72 | $661.58 |
| North Carolina | $1,558.04 | $637.80 |
| North Dakota** | $1,631.03 | $644.70 |
| Northern Nj | $1,882.06 | $737.92 |
| Nyc Suburbs/Long Island | $1,952.95 | $780.21 |
| Ohio | $1,549.36 | $648.84 |
| Oklahoma | $1,514.42 | $633.63 |
| Oxnard-Thousand Oaks-Ventura | $1,876.89 | $711.05 |
| Portland | $1,789.57 | $693.76 |
| Poughkpsie/N Nyc Suburbs | $1,800.88 | $720.85 |
| Puerto Rico | $1,670.02 | $672.84 |
| Queens | $1,926.11 | $760.27 |
| Redding | $1,762.22 | $681.21 |
| Rest Of California | $1,762.22 | $681.21 |
| Rest Of Florida | $1,624.40 | $681.47 |
| Rest Of Georgia | $1,531.34 | $651.53 |
| Rest Of Illinois | $1,573.64 | $673.12 |
| Rest Of Louisiana | $1,512.41 | $639.51 |
| Rest Of Maine | $1,541.16 | $633.74 |
| Rest Of Maryland | $1,672.05 | $673.88 |
| Rest Of Massachusetts | $1,719.88 | $681.28 |
| Rest Of Michigan | $1,554.65 | $654.13 |
| Rest Of Missouri | $1,484.55 | $634.34 |
| Rest Of New Jersey | $1,790.35 | $713.28 |
| Rest Of New York | $1,581.95 | $644.94 |
| Rest Of Oregon | $1,639.06 | $656.67 |
| Rest Of Pennsylvania | $1,552.81 | $647.36 |
| Rest Of Texas | $1,589.46 | $653.43 |
| Rest Of Washington | $1,717.19 | $678.59 |
| Rhode Island | $1,700.33 | $681.45 |
| Riverside-San Bernardino-Ontario | $1,776.46 | $695.45 |
| Sacramento-Roseville-Folsom | $1,852.47 | $705.37 |
| Salinas | $1,845.64 | $702.49 |
| San Diego-Chula Vista-Carlsbad | $1,891.47 | $711.82 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $2,177.68 | $786.96 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $2,176.20 | $785.47 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $2,226.36 | $804.07 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $2,220.28 | $797.99 |
| San Luis Obispo-Paso Robles | $1,815.61 | $692.18 |
| Santa Cruz-Watsonville | $1,911.45 | $713.06 |
| Santa Maria-Santa Barbara | $1,853.22 | $703.16 |
| Santa Rosa-Petaluma | $1,930.93 | $719.72 |
| Seattle (King Cnty) | $1,949.42 | $739.20 |
| South Carolina | $1,556.10 | $644.73 |
| South Dakota** | $1,627.97 | $641.64 |
| Southern Maine | $1,629.70 | $652.25 |
| Stockton | $1,762.22 | $681.21 |
| Suburban Chicago | $1,726.92 | $713.96 |
| Tennessee | $1,523.78 | $627.21 |
| Utah | $1,578.06 | $650.92 |
| Vallejo | $2,051.57 | $751.59 |
| Vermont | $1,622.99 | $646.52 |
| Virgin Islands | $1,670.02 | $672.84 |
| Virginia | $1,623.05 | $653.49 |
| Visalia | $1,762.22 | $681.21 |
| West Virginia | $1,513.24 | $656.12 |
| Wisconsin | $1,574.60 | $629.69 |
| Wyoming** | $1,645.64 | $659.31 |
| Yuba City | $1,762.22 | $681.21 |
21208 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$1,460.74
$1,994.29
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,903.95 | 1 |
| AL | $1,482.84 | 1 |
| AR | $1,460.74 | 1 |
| AZ | $1,612.23 | 1 |
| CA | $1,762.22–$2,226.36 | 29 |
| CO | $1,731.35 | 1 |
| CT | $1,769.24 | 1 |
| DC | $1,903.03 | 1 |
| DE | $1,639.56 | 1 |
| FL | $1,624.40–$1,774.82 | 3 |
| GA | $1,531.34–$1,686.79 | 2 |
| GU | $1,808.68 | 1 |
| HI | $1,808.68 | 1 |
| IA | $1,525.11 | 1 |
| ID | $1,534.64 | 1 |
| IL | $1,573.64–$1,726.92 | 4 |
| IN | $1,543.90 | 1 |
| KS | $1,516.13 | 1 |
| KY | $1,515.49 | 1 |
| LA | $1,512.41–$1,589.72 | 2 |
| MA | $1,719.88–$1,908.30 | 2 |
| MD | $1,672.05–$1,903.03 | 3 |
| ME | $1,541.16–$1,629.70 | 2 |
| MI | $1,554.65–$1,643.58 | 2 |
| MN | $1,662.22 | 1 |
| MO | $1,484.55–$1,597.51 | 3 |
| MS | $1,473.03 | 1 |
| MT | $1,656.93 | 1 |
| NC | $1,558.04 | 1 |
| ND | $1,631.03 | 1 |
| NE | $1,534.21 | 1 |
| NH | $1,702.45 | 1 |
| NJ | $1,790.35–$1,882.06 | 2 |
| NM | $1,562.77 | 1 |
| NV | $1,650.95 | 1 |
| NY | $1,581.95–$1,952.95 | 5 |
| OH | $1,549.36 | 1 |
| OK | $1,514.42 | 1 |
| OR | $1,639.06–$1,789.57 | 2 |
| PA | $1,552.81–$1,723.06 | 2 |
| PR | $1,670.02 | 1 |
| RI | $1,700.33 | 1 |
| SC | $1,556.10 | 1 |
| SD | $1,627.97 | 1 |
| TN | $1,523.78 | 1 |
| TX | $1,542.18–$1,724.78 | 8 |
| UT | $1,578.06 | 1 |
| VA | $1,623.05–$1,903.03 | 2 |
| VI | $1,670.02 | 1 |
| VT | $1,622.99 | 1 |
| WA | $1,717.19–$1,949.42 | 2 |
| WI | $1,574.60 | 1 |
| WV | $1,513.24 | 1 |
| WY | $1,645.64 | 1 |
How the 21208 rate is calculated
Each of 21208’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 · 21208
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.13Practice expense 37.17Malpractice 1.31
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21208
21208 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21208
Bone augmentation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21208
Bone augmentation
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21208 without 51 · national office
$1,657.02
Bone augmentation
21208-51 · Second procedure: 50%
$828.51
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%).
21208 compared with similar codes
Compare codes
21208 vs 21209 vs 21210 vs 21270 vs 21206: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21209Facial bone reduction
- Choose 21208 when the surgeon adds projection or support to facial bone; choose 21209 when the service reduces facial-bone prominence.
- 21210Facial bone graft
- 21210 describes bone grafting to nasal, maxillary, or malar areas. Use 21208 when the documented service is facial-bone augmentation rather than the graft service.
- 21270Cheek augmentation
- 21270 is associated specifically with cheekbone augmentation. Distinguish it from 21208 by the documented procedure and treated site.
- 21206Maxillary osteotomy
- 21206 describes reconstruction of the upper jaw. Use 21208 for facial-bone augmentation when the documented service is not upper-jaw reconstruction.
21208 billing questions
How is augmentation distinguished from facial-bone reduction?
Report augmentation when the surgeon adds projection or structural support to facial bone. Code 21209 describes reduction, which removes or decreases facial bone prominence.
When should cheekbone augmentation be considered separately?
Code 21270 is the nearby code specifically associated with cheekbone augmentation. Select the code that matches the documented operative site and service.
Does the 90-day global include related follow-up care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral augmentation?
No. CMS identifies bilateral adjustment as inappropriate for this code's descriptor or anatomy.
When is assistant-at-surgery payment allowed?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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
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