Billing code 21209: Facial bone reductionMedicare rate & RVUs

Medicare pays $801.96 for 21209 nationally in the office and $553.45 in a hospital or facility. Local office rates run $714.08–$1,043.78.

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

What 21209 covers

A surgeon reduces a prominent facial bone by removing or reshaping bone to change its contour. Plastic surgeons and oral and maxillofacial surgeons may perform this as facial skeletal contouring when the operative goal is to decrease bony prominence, rather than reconstruct a jaw or add volume with graft or implant material. The operative report should identify the bone treated and describe the reduction performed.

Report the service for the documented reduction, not for facial bone augmentation or bone grafting. Documentation should establish the treated site, the bony work performed, and the reason for contour reduction. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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. Modifier 50 is inappropriate for this code. 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 21209 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

21209 rates by state

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

How the 21209 rate is calculated

Each of 21209’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 21209

21209 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

21209 compared with similar codes

How to choose

21208Bone augmentation

21209 reduces facial bone prominence; 21208 addresses facial bone augmentation. Select based on whether the operation removes or reshapes bone to reduce prominence or adds volume.

21270Cheek augmentation

21270 is for cheekbone augmentation. Use 21209 when the documented procedure reduces facial bone prominence rather than augmenting the cheekbone.

21206Maxillary osteotomy

21206 describes reconstruction of the upper jaw. It is distinct from reduction performed to contour a facial bone without reconstructing the maxilla.

Codes related to 21209

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