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Billing code 21346: Midface fracture repairMedicare rate & RVUs

Reports open reduction and fixation of a Le Fort II-pattern nasomaxillary fracture when operative repair stabilizes the disrupted midface.

CMS RVU26DEffective Oct 1, 2026109 payment localities28 Medicare services in 2024

Medicare pays $913.85 for 21346 nationally in a facility.

Medicare rate · 21346

Midface fracture repair

Work RVUs
11.16
Total RVUs
27.36
Global days
090

National rate · 2026

$913.85

Facility setting, before claim adjustments.

See every locality for 21346 →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 21346 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 21346 covers

This service treats a displaced Le Fort II-pattern fracture involving the central midface, including the nasal bridge and maxillary region. The surgeon exposes the fracture, restores the bony alignment, and stabilizes it with fixation. Oral and maxillofacial surgeons, otolaryngologists, and plastic surgeons may perform the repair, usually in an operating room after significant facial trauma.

Report this code when the operative record supports open treatment with fixation and does not describe the multiple-approach or bone-graft distinctions represented by related codes. Documentation should identify the fracture pattern, exposure, reduction, and fixation performed. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is 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 21346 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

21346 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$829.39
Alaska*Unavailable$1,107.41
ArizonaUnavailable$890.92
ArkansasUnavailable$818.83
AtlantaUnavailable$933.70
AustinUnavailable$936.61
BakersfieldUnavailable$946.36
Baltimore/Surr. CntysUnavailable$968.24
BeaumontUnavailable$866.18
BrazoriaUnavailable$900.47

21346 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
21346 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 21346 rate is calculated

Each of 21346’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 · 21346

RVUs × geographic indexes × conversion factor

Work11.16

11.16 RVUs× 1.000 GPCI

Practice expense14.57

14.57 RVUs× 1.000 GPCI

Malpractice1.63

1.63 RVUs× 1.000 GPCI

Adjusted RVUs

27.3600

Conversion factor

$33.4009

Medicare rate

$913.85

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 21346

21346 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21346

Midface fracture repair

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)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
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 · 21346

Midface fracture repair

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

21346 without 51 · national facility

$913.85

Midface fracture repair

21346-51 · Second procedure: 50%

$456.93

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

21346 compared with similar codes

Compare codes · National

5 codes, side by side

  • 21346

    Midface fracture repair11.16 wRVU

    Not priced

  • 21345

    Midface fracture8.83 wRVU

    $799.28

  • 21347

    Nasomaxillary fracture repair13.19 wRVU

    Not priced

  • 21348

    Facial fracture repair17.08 wRVU

    Not priced

  • 21339

    Nasoethmoid repair8.29 wRVU

    Not priced

How to choose

21345Midface fracture
Choose 21345 for closed treatment of the nose-and-jaw fracture pattern; choose 21346 when the fracture is treated openly with fixation.
21347Nasomaxillary fracture repair
This code covers open fixation; 21347 distinguishes repair performed through multiple approaches.
21348Facial fracture repair
This code covers open fixation without the bone-graft distinction; 21348 is the graft-specific sibling.
21339Nasoethmoid repair
Code 21339 concerns an open nasoethmoid fracture treated with fixation, rather than the Le Fort II-pattern nasomaxillary fracture addressed here.

Codes related to 21346

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

Codes related to 21346
CodeHow it relatesNational office range
Used instead
21345Midface fractureClosed treatment for the corresponding nose-and-jaw fracture pattern.$713.35–$1,015.61
Same family
21347Nasomaxillary fracture repairOpen fixation of this fracture pattern with multiple approaches.No office rate
21348Facial fracture repairOpen treatment of this fracture pattern with a bone graft.No office rate

21346 billing questions

When is this code chosen over the closed-treatment code?

Use this code for open repair with fixation of a Le Fort II-pattern nasomaxillary fracture. Code 21345 describes closed treatment of the corresponding nose-and-jaw fracture pattern.

How does this differ from 21347 and 21348?

Code 21347 identifies treatment using multiple approaches, while 21348 identifies treatment with a bone graft. This code represents open fixation without those distinguishing features.

Is modifier 50 appropriate for bilateral fractures?

No. CMS identifies bilateral adjustment as 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.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is restricted for this code. Co-surgeons are paid only when supporting documentation is provided; team surgery is 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
RVUs for 21346PPRRVU2026_Oct_nonQPP.csv, line 1,956 (RVU26D)

Open CMS sourceHow we calculate rates

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