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Billing code 21435: Craniofacial fracture repairMedicare rate & RVUs

Reports open operative repair of a complicated LeFort III craniofacial separation when internal and/or external fixation is used to stabilize the fracture.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,261.55 for 21435 nationally in a facility.

Medicare rate · 21435

Craniofacial fracture repair

Swap in your local Medicare rate.

Work RVUs
19.75
Total RVUs
37.77
Global days
090

National rate · 2026

$1,261.55

Facility setting, before claim adjustments.

See every locality for 21435 → · 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 21435 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 21435 covers

This service treats a severe LeFort III pattern, in which the midface is separated from the cranial framework. The surgeon exposes and repositions the fracture and stabilizes it with internal fixation, external fixation, or both. Oral and maxillofacial surgeons, plastic surgeons, otolaryngologists, and other surgeons with craniofacial trauma expertise may perform the repair, commonly in a hospital operating room after major facial trauma.

Select this code when the documented injury and operative work support the complicated open-treatment level and internal and/or external fixation. The operative report should identify the craniofacial separation, the repair performed, and the fixation used; use the related code distinctions for wiring or splinting and for multiple approaches. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment may be made; 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 21435 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

21435 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,148.54
Alaska*Unavailable$1,567.67
ArizonaUnavailable$1,229.08
ArkansasUnavailable$1,134.63
AtlantaUnavailable$1,295.78
AustinUnavailable$1,276.75
BakersfieldUnavailable$1,272.33
Baltimore/Surr. CntysUnavailable$1,336.09
BeaumontUnavailable$1,209.71
BrazoriaUnavailable$1,235.62

21435 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
21435 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 21435 rate is calculated

Each of 21435’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 · 21435

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 19.75Practice expense 14.36Malpractice 3.66

37.7700 adjusted RVUs×$33.4009 conversion factor=$1,261.55

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

Payment rules and modifiers for 21435

21435 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21435

Craniofacial 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)0Not permitted.
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 · 21435

Craniofacial 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

21435 without 51 · national facility

$1,261.55

Craniofacial fracture repair

21435-51 · Second procedure: 50%

$630.78

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

21435 compared with similar codes

Compare codes

21435 vs 21431 vs 21433 vs 21436: national Medicare rates

Swap in your local Medicare rate.

  • 21435
    Craniofacial fracture repair · 19.75 wRVU
    —
  • 21431
    Fracture treatment · 7.7 wRVU
    —
  • 21433
    Craniofacial repair · 25.63 wRVU
    —
  • 21436
    Craniofacial fracture repair · 29.54 wRVU
    —

How to choose

21431Fracture treatment
21431 is for closed treatment of a LeFort III-type separation. Choose 21435 for open repair with internal and/or external fixation.
21433Craniofacial repair
21433 identifies complicated open repair with multiple approaches. 21435 identifies complicated repair with internal and/or external fixation.
21436Craniofacial fracture repair
21436 includes the multiple-approach distinction as well as internal and/or external fixation; 21435 is the fixation-level choice without that multiple-approach distinction.

Codes related to 21435

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

Codes related to 21435
CodeHow it relatesNational office range
Used instead
21431Fracture treatmentClosed treatment of a LeFort III-type craniofacial separation rather than open repair.No office rate
Same family
21432Craniofacial repairOpen treatment in the same fracture family, distinguished by wiring of dentition or splinting.No office rate
21433Craniofacial repairComplicated open repair distinguished by multiple approaches.No office rate
21436Craniofacial fracture repairComplicated repair combining multiple approaches with internal and/or external fixation.No office rate

21435 billing questions

How does 21435 differ from 21433?

21435 identifies complicated open repair using internal and/or external fixation. 21433 distinguishes complicated repair involving multiple approaches.

When would 21436 be selected instead?

Use 21436 when the documented complicated repair involves both multiple approaches and internal and/or external fixation.

How is 21435 different from 21431?

21431 describes closed treatment of a LeFort III-type separation. 21435 is for open operative repair with fixation.

Can an assistant surgeon be reported?

CMS indicates that assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted for this code.

What postoperative care is included?

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

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 21435PPRRVU2026_Oct_nonQPP.csv, line 1,980 (RVU26D)

Open CMS sourceHow we calculate rates

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