Billing code 21345: Midface fractureMedicare rate & RVUs
Reports closed treatment of a Le Fort II-pattern nasomaxillary fracture when stabilization uses dental wiring or a denture or splint.
Medicare pays $799.28 for 21345 nationally in the office and $568.15 in a hospital or facility. Local office rates run $713.35–$1,015.61.
Medicare rate · 21345
Midface fracture
Swap in your local Medicare rate.
- Work RVUs
- 8.83
- Total RVUs
- 23.93
- Global days
- 090
National rate · 2026
$799.28
Office setting, before claim adjustments.
See every locality for 21345 → · 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 21345 covers
This code describes closed management of a nasomaxillary complex fracture with a Le Fort II pattern. The fracture is treated without open surgical exposure, and stabilization uses interdental wiring or fixation of a denture or splint. Oral and maxillofacial surgeons, otolaryngologists, and facial plastic surgeons may perform the service, commonly in a hospital or operating-room setting. It is not the code for an isolated nasal bone fracture or a septal fracture.
Select the code when the documented fracture pattern and closed treatment method match this service. The operative report should identify the injury, explain the closed approach, and record the stabilization performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% 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 21345 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
$713.35 to $1015.61
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $722.93 | $520.68 |
| Alaska* | $957.38 | $711.23 |
| Arizona | $778.78 | $554.81 |
| Arkansas | $713.35 | $514.80 |
| Atlanta | $816.21 | $581.38 |
| Austin | $821.71 | $577.17 |
| Bakersfield | $832.32 | $579.00 |
| Baltimore/Surr. Cntys | $847.89 | $599.88 |
| Beaumont | $754.71 | $544.38 |
| Brazoria | $788.01 | $558.96 |
| Chicago | $859.45 | $627.16 |
| Chico | $828.59 | $575.26 |
| Colorado | $822.91 | $576.98 |
| Connecticut | $849.75 | $600.82 |
| Dallas | $793.97 | $563.76 |
| Dc + Md/Va Suburbs | $902.18 | $629.91 |
| Delaware | $790.87 | $562.51 |
| Detroit | $812.70 | $589.65 |
| East St. Louis | $806.07 | $593.43 |
| El Centro | $828.80 | $575.48 |
| Fort Lauderdale | $840.09 | $605.96 |
| Fort Worth | $789.92 | $562.02 |
| Fresno | $828.59 | $575.26 |
| Galveston | $791.00 | $561.49 |
| Hanford-Corcoran | $828.59 | $575.26 |
| Hawaii, Guam | $844.34 | $581.54 |
| Houston | $814.61 | $585.10 |
| Idaho | $739.68 | $527.03 |
| Indiana | $743.46 | $529.20 |
| Iowa | $734.09 | $522.61 |
| Kansas | $733.63 | $524.69 |
| Kentucky | $744.42 | $538.94 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $881.31 | $607.88 |
| Madera | $828.59 | $575.26 |
| Manhattan | $918.13 | $649.56 |
| Merced | $828.59 | $575.26 |
| Metropolitan Boston | $896.12 | $620.15 |
| Metropolitan Kansas City | $770.16 | $553.12 |
| Metropolitan Philadelphia | $831.82 | $591.21 |
| Metropolitan St. Louis | $777.23 | $557.19 |
| Miami | $884.08 | $643.46 |
| Minnesota | $782.33 | $544.49 |
| Mississippi | $723.92 | $524.92 |
| Modesto | $828.59 | $575.26 |
| Montana** | $799.20 | $568.06 |
| Napa | $943.35 | $638.71 |
| Nebraska | $736.97 | $523.63 |
| Nevada** | $792.55 | $561.18 |
| New Hampshire | $812.81 | $572.20 |
| New Mexico | $769.66 | $557.71 |
| New Orleans | $777.93 | $560.43 |
| North Carolina | $752.82 | $537.18 |
| North Dakota** | $773.69 | $542.56 |
| Northern Nj | $894.60 | $626.48 |
| Nyc Suburbs/Long Island | $942.26 | $667.45 |
| Ohio | $759.50 | $548.47 |
| Oklahoma | $740.32 | $533.92 |
| Oxnard-Thousand Oaks-Ventura | $875.25 | $602.05 |
| Portland | $844.17 | $587.38 |
| Poughkpsie/N Nyc Suburbs | $865.42 | $612.33 |
| Puerto Rico | $803.71 | $570.03 |
| Queens | $921.15 | $647.95 |
| Redding | $828.59 | $575.26 |
| Rest Of California | $828.59 | $575.26 |
| Rest Of Florida | $800.66 | $579.70 |
| Rest Of Georgia | $757.74 | $551.57 |
| Rest Of Illinois | $783.41 | $572.39 |
| Rest Of Louisiana | $744.43 | $539.87 |
| Rest Of Maine | $746.10 | $533.45 |
| Rest Of Maryland | $804.23 | $570.33 |
| Rest Of Massachusetts | $819.70 | $576.32 |
| Rest Of Michigan | $764.71 | $553.69 |
| Rest Of Missouri | $734.51 | $535.27 |
| Rest Of New Jersey | $857.70 | $605.30 |
| Rest Of New York | $763.42 | $543.85 |
| Rest Of Oregon | $784.64 | $554.43 |
| Rest Of Pennsylvania | $759.09 | $546.91 |
| Rest Of Texas | $771.58 | $552.23 |
| Rest Of Washington | $817.27 | $573.88 |
| Rhode Island | $815.46 | $576.69 |
| Riverside-San Bernardino-Ontario | $842.54 | $589.22 |
| Sacramento-Roseville-Folsom | $865.10 | $596.29 |
| Salinas | $861.78 | $593.89 |
| San Diego-Chula Vista-Carlsbad | $878.81 | $602.37 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $993.11 | $667.21 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $991.65 | $665.75 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,015.61 | $682.32 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,009.62 | $676.33 |
| San Luis Obispo-Paso Robles | $848.42 | $585.16 |
| Santa Cruz-Watsonville | $884.66 | $603.83 |
| Santa Maria-Santa Barbara | $864.12 | $594.62 |
| Santa Rosa-Petaluma | $893.31 | $609.47 |
| Seattle (King Cnty) | $910.85 | $627.25 |
| South Carolina | $757.76 | $544.20 |
| South Dakota** | $770.67 | $539.54 |
| Southern Maine | $779.23 | $550.18 |
| Stockton | $828.59 | $575.26 |
| Suburban Chicago | $847.07 | $609.69 |
| Tennessee | $737.36 | $527.26 |
| Utah | $767.21 | $549.95 |
| Vallejo | $941.24 | $636.60 |
| Vermont | $773.39 | $544.56 |
| Virgin Islands | $803.71 | $570.03 |
| Virginia | $778.77 | $551.57 |
| Visalia | $828.59 | $575.26 |
| West Virginia | $757.43 | $556.57 |
| Wisconsin | $750.09 | $528.67 |
| Wyoming** | $788.08 | $556.95 |
| Yuba City | $828.59 | $575.26 |
21345 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.
$713.35
$957.38
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 | $957.38 | 1 |
| AL | $722.93 | 1 |
| AR | $713.35 | 1 |
| AZ | $778.78 | 1 |
| CA | $828.59–$1,015.61 | 29 |
| CO | $822.91 | 1 |
| CT | $849.75 | 1 |
| DC | $902.18 | 1 |
| DE | $790.87 | 1 |
| FL | $800.66–$884.08 | 3 |
| GA | $757.74–$816.21 | 2 |
| GU | $844.34 | 1 |
| HI | $844.34 | 1 |
| IA | $734.09 | 1 |
| ID | $739.68 | 1 |
| IL | $783.41–$859.45 | 4 |
| IN | $743.46 | 1 |
| KS | $733.63 | 1 |
| KY | $744.42 | 1 |
| LA | $744.43–$777.93 | 2 |
| MA | $819.70–$896.12 | 2 |
| MD | $804.23–$902.18 | 3 |
| ME | $746.10–$779.23 | 2 |
| MI | $764.71–$812.70 | 2 |
| MN | $782.33 | 1 |
| MO | $734.51–$777.23 | 3 |
| MS | $723.92 | 1 |
| MT | $799.20 | 1 |
| NC | $752.82 | 1 |
| ND | $773.69 | 1 |
| NE | $736.97 | 1 |
| NH | $812.81 | 1 |
| NJ | $857.70–$894.60 | 2 |
| NM | $769.66 | 1 |
| NV | $792.55 | 1 |
| NY | $763.42–$942.26 | 5 |
| OH | $759.50 | 1 |
| OK | $740.32 | 1 |
| OR | $784.64–$844.17 | 2 |
| PA | $759.09–$831.82 | 2 |
| PR | $803.71 | 1 |
| RI | $815.46 | 1 |
| SC | $757.76 | 1 |
| SD | $770.67 | 1 |
| TN | $737.36 | 1 |
| TX | $754.71–$821.71 | 8 |
| UT | $767.21 | 1 |
| VA | $778.77–$902.18 | 2 |
| VI | $803.71 | 1 |
| VT | $773.39 | 1 |
| WA | $817.27–$910.85 | 2 |
| WI | $750.09 | 1 |
| WV | $757.43 | 1 |
| WY | $788.08 | 1 |
How the 21345 rate is calculated
Each of 21345’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 · 21345
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.83Practice expense 13.81Malpractice 1.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21345
21345 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21345
Midface fracture
| 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 · 21345
Midface fracture
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
21345 without 51 · national office
$799.28
Midface fracture
21345-51 · Second procedure: 50%
$399.64
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%).
21345 compared with similar codes
Compare codes
21345 vs 21346 vs 21315 vs 21320: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21346Midface fracture repair
- Both address a Le Fort II-pattern nasomaxillary fracture. Choose 21345 for the specified closed stabilization and 21346 when treatment uses an open approach.
- 21315Nasal fracture treatment
- 21315 describes closed treatment of a nasal bone fracture without manipulation. It is for an isolated nasal fracture, not the Le Fort II-pattern nasomaxillary injury reported with 21345.
- 21320Nasal fracture treatment
- 21320 is for a nasal bone fracture treated with manipulation and stabilization. It does not represent closed treatment of a Le Fort II-pattern nasomaxillary fracture.
21345 billing questions
How is this different from 21346?
This code is for closed treatment of a Le Fort II-pattern nasomaxillary fracture with the specified stabilization. Use 21346 when the fracture is treated through an open approach.
Can this be reported for an isolated nasal bone fracture?
No. This code describes treatment of a nasomaxillary complex fracture with a Le Fort II pattern. Codes 21315 or 21320 address closed treatment of nasal bone fractures, depending on the treatment performed.
What documentation supports reporting this code?
Document the Le Fort II-pattern fracture, that treatment was closed, and the stabilization method, such as interdental wiring or fixation of a denture or splint.
Should modifier 50 be appended for bilateral fractures?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How are multiple procedures and surgical assistance handled?
For procedures performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Assistant-at-surgery payment requires documented medical necessity; 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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