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Billing code 21465: Mandibular fracture repairMedicare rate & RVUs

Report 21465 for open surgical treatment of a fracture involving the mandibular condyle, the part of the jaw that forms the temporomandibular joint.

CMS RVU26DEffective Oct 1, 2026109 payment localities27 Medicare services in 2024

Medicare pays $723.80 for 21465 nationally in a facility.

Medicare rate · 21465

Mandibular fracture repair

Swap in your local Medicare rate.

Work RVUs
12.79
Total RVUs
21.67
Global days
090

National rate · 2026

$723.80

Facility setting, before claim adjustments.

See every locality for 21465 → · 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 21465 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 21465 covers

This service involves surgically exposing and realigning a fractured mandibular condyle, with fixation used when needed to stabilize the fragments. It is typically performed in an operating room by an oral and maxillofacial surgeon, or another surgeon qualified to treat facial fractures. The operative record should identify the condylar fracture and describe the open approach and treatment performed. A fracture managed without surgical exposure is not reported with this code.

Select 21465 for the open treatment of a condylar fracture, rather than a general mandibular fracture code or a code for closed management. Documentation should establish the fracture site and the surgical work; note fixation and any additional fracture procedures performed during the session. Medicare assigns a 90-day global period, including 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 at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons are paid only with 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 21465 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

21465 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$671.65
Alaska*Unavailable$931.61
ArizonaUnavailable$709.09
ArkansasUnavailable$665.20
AtlantaUnavailable$738.85
AustinUnavailable$733.47
BakersfieldUnavailable$736.64
Baltimore/Surr. CntysUnavailable$760.28
BeaumontUnavailable$698.03
BrazoriaUnavailable$714.26

21465 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
21465 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 21465 rate is calculated

Each of 21465’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 · 21465

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.79Practice expense 7.42Malpractice 1.46

21.6700 adjusted RVUs×$33.4009 conversion factor=$723.80

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

Payment rules and modifiers for 21465

21465 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21465

Mandibular 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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 21465

Mandibular 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 50 · payment effect

With and without the modifier

21465 without 50 · national facility

$723.80

Mandibular fracture repair

21465-50 · Bilateral: 150%

$1,085.70

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

21465 compared with similar codes

Compare codes

21465 vs 21461 vs 21462 vs 21454 vs 21470: national Medicare rates

Swap in your local Medicare rate.

  • 21465
    Mandibular fracture repair · 12.79 wRVU
    —
  • 21461
    Mandibular fracture repair · 9.08 wRVU
    $1,791.29
  • 21462
    Mandibular fracture repair · 10.73 wRVU
    $2,034.78
  • 21454
    Mandibular fracture repair · 7.18 wRVU
    —
  • 21470
    Mandibular fracture repair · 17.1 wRVU
    —

How to choose

21461Mandibular fracture repair
Use 21465 when the open repair is specifically for a mandibular condylar fracture. Code 21461 describes open mandibular fracture treatment without interdental fixation.
21462Mandibular fracture repair
21462 describes open mandibular fracture treatment with interdental fixation. For an open condylar fracture, use the condylar-specific 21465.
21454Mandibular fracture repair
21454 describes open mandibular fracture treatment with external fixation. 21465 identifies open treatment of a condylar fracture.
21470Mandibular fracture repair
21470 is for complicated mandibular fracture treatment involving multiple approaches. 21465 identifies the condylar fracture service.

Codes related to 21465

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

Codes related to 21465
CodeHow it relatesNational office range
Same family
21461Mandibular fracture repairOpen mandibular fracture treatment without interdental fixation; 21465 specifies the condylar site.$1,566.43–$2,442.71
21462Mandibular fracture repairOpen mandibular fracture treatment with interdental fixation; distinguish the condylar-specific service.$1,779.91–$2,766.45
21454Mandibular fracture repairOpen mandibular fracture treatment using external fixation.No office rate
21470Mandibular fracture repairOpen treatment for a complicated mandibular fracture using multiple approaches.No office rate
Used instead
21450Mandibular fracture careClosed mandibular fracture treatment without manipulation, when open treatment is not performed.$525.91–$809.59
21451Mandibular fractureClosed mandibular fracture treatment with manipulation, rather than open condylar repair.$688.77–$1,044.77

21465 billing questions

How does 21465 differ from 21461 or 21462?

21465 identifies open treatment of a mandibular condylar fracture. Codes 21461 and 21462 describe open mandibular fracture treatment without the condylar-specific designation; 21462 includes interdental fixation.

Can 21465 be reported for a fracture treated without open surgery?

No. Use a code for the applicable closed or percutaneous treatment when the fracture is managed without open surgical exposure.

How should bilateral condylar fractures be reported?

When the service is bilateral, report modifier 50; CMS pays the bilateral procedure at 150%.

What postoperative care is included?

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

Can an assistant or co-surgeon be billed?

Assistant-at-surgery payment may be available. Co-surgeons are paid only when supporting documentation is submitted; 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 21465PPRRVU2026_Oct_nonQPP.csv, line 1,991 (RVU26D)

Open CMS sourceHow we calculate rates

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