$3,640.22
21215 describes bone grafting to the mandible. Report 21247 when the documented service is the broader lower-jaw reconstruction, not graft placement alone.
On this page
CMS RVU26D · Effective 2026-10-01
21247 Lower jaw reconstruction Medicare reimbursement rates in Alabama
Reports major reconstructive surgery to restore lower-jaw bone, such as after substantial mandibular bone loss from trauma or tumor treatment. Compare 21247 office and facility rates across CMS payment localities in Alabama.
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 21247 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1305.40
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
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.
Oral and maxillofacial surgery
About 21247: Mandibular bone reconstruction
Reports major reconstructive surgery to restore lower-jaw bone, such as after substantial mandibular bone loss from trauma or tumor treatment.
This code represents a major operation to reconstruct the mandible when bone has been lost or the jaw requires structural restoration. Oral and maxillofacial surgeons, plastic surgeons, and other surgeons with relevant expertise may perform the procedure in a hospital or other surgical facility. Clinical situations can include reconstruction after removal of a mandibular tumor or repair of major traumatic bone loss. The operative report should make clear the defect being reconstructed and the technique used.
Select this code based on the documented reconstructive service, distinguishing it from a bone graft alone and from other mandibular reconstruction methods in the neighboring codes. The record should identify the cause and extent of the defect, the reconstruction performed, and any graft or reconstructive materials used. 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 procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21247
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU23.76 · 56%
- Practice expense (office) RVU15.28 · 36%
- Malpractice RVU3.45 · 8%
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.
21247 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
21244 is a neighboring mandibular reconstruction code with distinct operative criteria. Choose between the codes from the specific reconstruction method documented in the operative report.
$931.75
21248 is an endosteal-implant reconstruction code. It is not interchangeable with this code when the documented procedure is a different form of mandibular reconstruction.
$1,281.51
21249 is another endosteal-implant reconstruction option. The operative technique and extent documented determine whether it or 21247 describes the service.
Compare 21247 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.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$1305.40
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21247 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,926
- Code
- 21247
- Physician work
- 23.76
- Practice expense
- 15.28
- Malpractice
- 3.45
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.76 | × 1.000 | 23.7600 |
| Practice expense | 15.28 | × 0.875 | 13.3700 |
| Malpractice | 3.45 | × 0.566 | 1.9527 |
| Total RVUs | 39.0827 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$1305.40
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.76 | 1 |
| Practice expense | 15.28 | 0.875 |
| Malpractice | 3.45 | 0.566 |
(23.76 × 1 + 15.28 × 0.875 + 3.45 × 0.566) × $33.4009 = $1305.40
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21247 billing questions
How is this different from a mandibular bone graft code?
This code represents reconstruction of the lower jaw, rather than bone grafting as a standalone service. Use the operative documentation to distinguish the complete reconstructive procedure from graft placement alone.
What documentation supports reporting this code?
Document the mandibular defect or bone loss, its cause, the reconstruction performed, and the technique and materials used. The operative report should support why the service is a reconstruction rather than an isolated graft.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The procedure is major surgery under the CMS global-period rule.
Can this code be reported bilaterally?
CMS identifies it as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support reconstruction on both sides.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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 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.
1,92321244,,Reconstruction of lower jaw,A,,13.28,11.65,NA,11.65,,1.94,26.87,26.87,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92421245,,Reconstruction of jaw,A,,12.79,23.87,,11.31,,1.85,38.51,25.95,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92521246,,Reconstruction of jaw,A,,12.60,8.56,NA,8.56,,1.83,22.99,22.99,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92621247,,Reconstruct lower jaw bone,A,,23.76,15.28,NA,15.28,,3.45,42.49,42.49,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92721248,,Reconstruction of jaw,A,,12.42,16.71,,7.79,,1.51,30.64,21.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92821249,,Reconstruction of jaw,A,,18.30,21.44,,9.64,,2.31,42.05,30.25,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92921255,,Reconstruct lower jaw bone,A,,18.00,15.95,NA,15.95,,2.61,36.56,36.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515