$722.93
Choose 21345 for closed treatment of the nose-and-jaw fracture pattern; choose 21346 when the fracture is treated openly with fixation.
On this page
CMS RVU26D · Effective 2026-10-01
21346 Midface fracture repair Medicare reimbursement rates in Alabama
Reports open reduction and fixation of a Le Fort II-pattern nasomaxillary fracture when operative repair stabilizes the disrupted midface. Compare 21346 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 21346 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
$829.39
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.
Facial fracture surgery
About 21346: Open fixation of Le Fort II fracture
Reports open reduction and fixation of a Le Fort II-pattern nasomaxillary fracture when operative repair stabilizes the disrupted midface.
This service treats a displaced Le Fort II-pattern fracture involving the central midface, including the nasal bridge and maxillary region. The surgeon exposes the fracture, restores the bony alignment, and stabilizes it with fixation. Oral and maxillofacial surgeons, otolaryngologists, and plastic surgeons may perform the repair, usually in an operating room after significant facial trauma.
Report this code when the operative record supports open treatment with fixation and does not describe the multiple-approach or bone-graft distinctions represented by related codes. Documentation should identify the fracture pattern, exposure, reduction, and fixation performed. The major-surgery global period includes 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 are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21346
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.16 · 41%
- Practice expense (office) RVU14.57 · 53%
- Malpractice RVU1.63 · 6%
28
Medicare services in 2024 · #5699 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.
21346 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
This code covers open fixation; 21347 distinguishes repair performed through multiple approaches.
No office rate
This code covers open fixation without the bone-graft distinction; 21348 is the graft-specific sibling.
No office rate
Code 21339 concerns an open nasoethmoid fracture treated with fixation, rather than the Le Fort II-pattern nasomaxillary fracture addressed here.
Compare 21346 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
$829.39
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 21346 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,956
- Code
- 21346
- Physician work
- 11.16
- Practice expense
- 14.57
- Malpractice
- 1.63
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.16 | × 1.000 | 11.1600 |
| Practice expense | 14.57 | × 0.875 | 12.7488 |
| Malpractice | 1.63 | × 0.566 | 0.9226 |
| Total RVUs | 24.8313 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$829.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.16 | 1 |
| Practice expense | 14.57 | 0.875 |
| Malpractice | 1.63 | 0.566 |
(11.16 × 1 + 14.57 × 0.875 + 1.63 × 0.566) × $33.4009 = $829.39
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.
21346 billing questions
When is this code chosen over the closed-treatment code?
Use this code for open repair with fixation of a Le Fort II-pattern nasomaxillary fracture. Code 21345 describes closed treatment of the corresponding nose-and-jaw fracture pattern.
How does this differ from 21347 and 21348?
Code 21347 identifies treatment using multiple approaches, while 21348 identifies treatment with a bone graft. This code represents open fixation without those distinguishing features.
Is modifier 50 appropriate for bilateral fractures?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted for this code. 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.
1,95321343,,Open tx dprsd front sinus fx,A,,13.96,13.17,NA,13.17,,2.05,29.18,29.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95421344,,Open tx compl front sinus fx,A,,21.03,12.31,NA,12.31,,3.05,36.39,36.39,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95521345,,Closed tx nose/jaw fx,A,,8.83,13.81,,6.89,,1.29,23.93,17.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95621346,,Opn tx nasomax fx w/fixj,A,,11.16,14.57,NA,14.57,,1.63,27.36,27.36,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95721347,,Opn tx nasomax fx multple,A,,13.19,13.01,NA,13.01,,1.92,28.12,28.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95821348,,Opn tx nasomax fx w/graft,A,,17.08,8.81,NA,8.81,,2.49,28.38,28.38,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95921355,,Perq tx malar fracture,A,,4.34,8.38,,3.85,,0.62,13.34,8.81,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,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