No office rate
21431 is closed treatment of a craniofacial separation. Choose 21433 for complicated open repair through multiple approaches.
On this page
CMS RVU26D · Effective 2026-10-01
21433 Craniofacial repair Medicare reimbursement rates
Reports complicated open repair of a LeFort III-type craniofacial separation when the surgeon uses multiple operative approaches to treat the injury. Compare 21433 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 21433?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 21433 pays more and less
Maxillofacial surgery
About 21433: Complicated craniofacial separation repair
Reports complicated open repair of a LeFort III-type craniofacial separation when the surgeon uses multiple operative approaches to treat the injury.
This code describes open repair of a severe craniofacial separation of the LeFort III type using multiple operative approaches. The surgeon exposes and realigns the separated facial skeleton and stabilizes the repair as clinically required. Oral and maxillofacial surgeons, plastic surgeons, and other surgeons with craniofacial expertise may perform this operation, generally in a hospital operating room after major facial trauma.
Choose this code when the documented injury and operation support complicated open treatment through multiple approaches; the operative report should establish the fracture pattern, complexity, approaches used, and repair performed. It has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21433
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU25.63 · 56%
- Practice expense (office) RVU15.31 · 34%
- Malpractice RVU4.76 · 10%
23
Medicare services in 2024 · #5831 by national volume
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.
21433 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
21432 describes open treatment with wiring. Code 21433 is for complicated multiple-approach repair, not simply the use of wiring.
No office rate
21435 identifies complicated open treatment with internal and/or external fixation. Code 21433 distinguishes complicated treatment using multiple approaches.
No office rate
21436 is the multiple-approach sibling that specifies internal fixation. Use 21433 when that specific internal-fixation distinction is not the basis for code selection.
See how rates vary across the country
21433 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 21433 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1393.50 |
| Alaska* | Office Unavailable | Facility $1916.31 |
| Arizona | Office Unavailable | Facility $1487.67 |
| Arkansas | Office Unavailable | Facility $1377.21 |
| Atlanta | Office Unavailable | Facility $1569.13 |
| Austin | Office Unavailable | Facility $1539.67 |
| Bakersfield | Office Unavailable | Facility $1529.61 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1615.13 |
| Beaumont | Office Unavailable | Facility $1469.11 |
| Brazoria | Office Unavailable | Facility $1493.69 |
| Chicago | Office Unavailable | Facility $1740.86 |
| Chico | Office Unavailable | Facility $1516.29 |
| Colorado | Office Unavailable | Facility $1534.60 |
| Connecticut | Office Unavailable | Facility $1616.31 |
| Dallas | Office Unavailable | Facility $1509.50 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1681.64 |
| Delaware | Office Unavailable | Facility $1508.51 |
| Detroit | Office Unavailable | Facility $1617.59 |
| East St. Louis | Office Unavailable | Facility $1646.73 |
| El Centro | Office Unavailable | Facility $1517.09 |
| Fort Lauderdale | Office Unavailable | Facility $1661.53 |
| Fort Worth | Office Unavailable | Facility $1506.46 |
| Fresno | Office Unavailable | Facility $1516.29 |
| Galveston | Office Unavailable | Facility $1502.34 |
| Hanford-Corcoran | Office Unavailable | Facility $1516.29 |
| Hawaii, Guam | Office Unavailable | Facility $1529.54 |
| Houston | Office Unavailable | Facility $1589.47 |
| Idaho | Office Unavailable | Facility $1401.72 |
| Indiana | Office Unavailable | Facility $1407.37 |
| Iowa | Office Unavailable | Facility $1387.08 |
| Kansas | Office Unavailable | Facility $1398.47 |
| Kentucky | Office Unavailable | Facility $1456.15 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1601.68 |
| Madera | Office Unavailable | Facility $1516.29 |
| Manhattan | Office Unavailable | Facility $1757.22 |
| Merced | Office Unavailable | Facility $1516.29 |
| Metropolitan Boston | Office Unavailable | Facility $1643.24 |
| Metropolitan Kansas City | Office Unavailable | Facility $1491.57 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1593.48 |
| Metropolitan St. Louis | Office Unavailable | Facility $1502.19 |
| Miami | Office Unavailable | Facility $1790.48 |
| Minnesota | Office Unavailable | Facility $1429.32 |
| Mississippi | Office Unavailable | Facility $1413.85 |
| Modesto | Office Unavailable | Facility $1516.29 |
| Montana** | Office Unavailable | Facility $1526.10 |
| Napa | Office Unavailable | Facility $1664.75 |
| Nebraska | Office Unavailable | Facility $1388.16 |
| Nevada** | Office Unavailable | Facility $1500.38 |
| New Hampshire | Office Unavailable | Facility $1527.51 |
| New Mexico | Office Unavailable | Facility $1515.93 |
| New Orleans | Office Unavailable | Facility $1517.87 |
| North Carolina | Office Unavailable | Facility $1434.76 |
| North Dakota** | Office Unavailable | Facility $1431.98 |
| Northern Nj | Office Unavailable | Facility $1672.98 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1814.11 |
| Ohio | Office Unavailable | Facility $1483.20 |
| Oklahoma | Office Unavailable | Facility $1436.25 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1583.52 |
| Portland | Office Unavailable | Facility $1556.18 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1646.91 |
| Puerto Rico | Office Unavailable | Facility $1529.66 |
| Queens | Office Unavailable | Facility $1744.55 |
| Redding | Office Unavailable | Facility $1516.29 |
| Rest Of California | Office Unavailable | Facility $1516.29 |
| Rest Of Florida | Office Unavailable | Facility $1583.89 |
| Rest Of Georgia | Office Unavailable | Facility $1501.72 |
| Rest Of Illinois | Office Unavailable | Facility $1571.44 |
| Rest Of Louisiana | Office Unavailable | Facility $1460.94 |
| Rest Of Maine | Office Unavailable | Facility $1425.41 |
| Rest Of Maryland | Office Unavailable | Facility $1528.08 |
| Rest Of Massachusetts | Office Unavailable | Facility $1534.95 |
| Rest Of Michigan | Office Unavailable | Facility $1502.44 |
| Rest Of Missouri | Office Unavailable | Facility $1451.72 |
| Rest Of New Jersey | Office Unavailable | Facility $1623.13 |
| Rest Of New York | Office Unavailable | Facility $1453.63 |
| Rest Of Oregon | Office Unavailable | Facility $1477.16 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1475.74 |
| Rest Of Texas | Office Unavailable | Facility $1484.92 |
| Rest Of Washington | Office Unavailable | Facility $1526.65 |
| Rhode Island | Office Unavailable | Facility $1542.39 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1567.55 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1566.82 |
| Salinas | Office Unavailable | Facility $1560.50 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1579.51 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1731.40 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1725.99 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1772.84 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1750.74 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1538.28 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1580.57 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1561.51 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1594.92 |
| Seattle (King Cnty) | Office Unavailable | Facility $1656.21 |
| South Carolina | Office Unavailable | Facility $1463.71 |
| South Dakota** | Office Unavailable | Facility $1420.85 |
| Southern Maine | Office Unavailable | Facility $1463.15 |
| Stockton | Office Unavailable | Facility $1516.29 |
| Suburban Chicago | Office Unavailable | Facility $1668.96 |
| Tennessee | Office Unavailable | Facility $1406.28 |
| Utah | Office Unavailable | Facility $1479.52 |
| Vallejo | Office Unavailable | Facility $1656.96 |
| Vermont | Office Unavailable | Facility $1442.77 |
| Virgin Islands | Office Unavailable | Facility $1529.66 |
| Virginia | Office Unavailable | Facility $1470.99 |
| Visalia | Office Unavailable | Facility $1516.29 |
| West Virginia | Office Unavailable | Facility $1527.96 |
| Wisconsin | Office Unavailable | Facility $1394.92 |
| Wyoming** | Office Unavailable | Facility $1485.08 |
| Yuba City | Office Unavailable | Facility $1516.29 |
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21433 billing questions
When should this code be selected instead of 21431?
Use 21433 for complicated open repair of a LeFort III-type separation involving multiple approaches. Code 21431 describes closed treatment of the separation.
How does this differ from 21432?
Code 21432 describes open treatment with wiring of the bones. For 21433, the documented procedure must support complicated treatment using multiple approaches.
What documentation supports reporting 21433?
The operative report should identify the LeFort III-type craniofacial separation, explain its complexity, and describe the multiple approaches and repair performed.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative care?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,97621423,,Optx palatal/max fx comp,A,,10.58,9.07,NA,9.07,,1.96,21.61,21.61,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97721431,,Cltx craniofacial separation,A,,7.70,10.79,NA,10.79,,0.88,19.37,19.37,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97821432,,Optx cranfcl sep w/wiring,A,,8.60,9.93,NA,9.93,,1.59,20.12,20.12,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97921433,,Optx cranfcl sep comp mlt,A,,25.63,15.31,NA,15.31,,4.76,45.70,45.70,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98021435,,Optx crnfc sep comp int&/xtr,A,,19.75,14.36,NA,14.36,,3.66,37.77,37.77,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98121436,,Optx crnfcl sep comp mlt int,A,,29.54,19.00,NA,19.00,,5.49,54.03,54.03,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98221440,,Cltx mndblr/max alv ridge fx,A,,3.35,19.95,,14.18,,0.48,23.78,18.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00