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Billing code 21422: Maxillary fracture repairMedicare rate & RVUs

Open operative repair of a palatal or maxillary fracture is reported when surgical exposure and reduction are performed rather than closed stabilization.

CMS RVU26DEffective Oct 1, 2026109 payment localities90 Medicare services in 2024

Medicare pays $590.19 for 21422 nationally in a facility.

Medicare rate · 21422

Maxillary fracture repair

Swap in your local Medicare rate.

Work RVUs
8.51
Total RVUs
17.67
Global days
090

National rate · 2026

$590.19

Facility setting, before claim adjustments.

See every locality for 21422 → · 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 21422 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 21422 covers

Code 21422 represents operative repair of a palatal or maxillary fracture, commonly a Le Fort I-pattern injury, with surgical exposure and restoration of alignment. Oral and maxillofacial surgeons, plastic surgeons, or otolaryngologists may perform the repair in a hospital or ambulatory surgical setting; fixation stabilizes the reduced fracture as part of the operative treatment.

Report it when the operative record supports open rather than closed management and identifies the fracture pattern, exposure, reduction, and stabilization. Distinguish 21421 for closed treatment with wire fixation and 21423 when the case meets the more complicated, multiple-approach level. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires 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 21422 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

21422 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$539.15
Alaska*Unavailable$730.91
ArizonaUnavailable$576.03
ArkansasUnavailable$532.81
AtlantaUnavailable$603.60
AustinUnavailable$601.38
BakersfieldUnavailable$604.80
Baltimore/Surr. CntysUnavailable$623.87
BeaumontUnavailable$563.45
BrazoriaUnavailable$580.98

21422 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
21422 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 21422 rate is calculated

Each of 21422’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 · 21422

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.51Practice expense 7.92Malpractice 1.24

17.6700 adjusted RVUs×$33.4009 conversion factor=$590.19

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

Payment rules and modifiers for 21422

21422 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21422

Maxillary 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)2Paid.
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 · 21422

Maxillary 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.

  • 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

21422 without 51 · national facility

$590.19

Maxillary fracture repair

21422-51 · Second procedure: 50%

$295.10

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

21422 compared with similar codes

Compare codes

21422 vs 21421 vs 21423 vs 21445: national Medicare rates

Swap in your local Medicare rate.

  • 21422
    Maxillary fracture repair · 8.51 wRVU
    —
  • 21421
    Fracture fixation · 5.87 wRVU
    $660.00
  • 21423
    Fracture repair · 10.58 wRVU
    —
  • 21445
    Alveolar fracture · 6.1 wRVU
    $753.19

How to choose

21421Fracture fixation
21421 describes closed treatment with wire fixation. Choose 21422 when the surgeon uses an open operative approach to reduce the palatal or maxillary fracture.
21423Fracture repair
21423 is the more complicated open-treatment level involving multiple approaches. Use 21422 for open repair that does not meet that level.
21445Alveolar fracture
21445 is for open treatment of an alveolar ridge fracture. Use 21422 for a palatal or broader maxillary fracture rather than an isolated ridge injury.

Codes related to 21422

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

Codes related to 21422
CodeHow it relatesNational office range
Same family
21421Fracture fixationClosed-treatment counterpart for a palatal or maxillary fracture.$587.00–$866.66
21423Fracture repairRelated open-treatment level for complicated cases involving multiple approaches.No office rate
Used instead
21440Fracture treatmentClosed treatment for an isolated maxillary or mandibular alveolar ridge fracture.$692.54–$1,093.67
21445Alveolar fractureOpen treatment for an isolated maxillary or mandibular alveolar ridge fracture.$667.79–$997.58

21422 billing questions

How does 21422 differ from 21421?

Use 21422 for open operative treatment involving surgical exposure and reduction. Code 21421 describes closed treatment with wire fixation.

When is 21423 a better fit?

Use 21423 when the documented repair meets the more complicated, multiple-approach level. The operative report should support that greater complexity rather than merely describe routine open repair.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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 21422PPRRVU2026_Oct_nonQPP.csv, line 1,975 (RVU26D)

Open CMS sourceHow we calculate rates

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