No office rate
Both describe complicated open repair using multiple approaches; 21436 is distinguished by internal fixation.
On this page
CMS RVU26D · Effective 2026-10-01
21436 Craniofacial fracture repair Medicare reimbursement rates in Alabama
Reports complex open repair of a LeFort III-type craniofacial separation when multiple surgical approaches and internal fixation are used. Compare 21436 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 21436 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
$1645.74
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.
Craniofacial surgery
About 21436: Complex LeFort III fracture repair
Reports complex open repair of a LeFort III-type craniofacial separation when multiple surgical approaches and internal fixation are used.
This service treats a severe LeFort III-type injury that separates the midface from the cranial base. The surgeon exposes and reduces the fracture through multiple surgical approaches, then stabilizes the repaired bones with internal fixation. It is typically performed by an oral and maxillofacial, plastic, or craniofacial surgeon in an operating room after major facial trauma.
Report this level when the operative record supports the complex fracture pattern, multiple approaches, and internal fixation; a simpler open repair or wiring-only treatment belongs to a different level. 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 50% reduction. Assistant-at-surgery payment may be available, and co-surgeons are permitted; team surgery billing is not permitted.
CMS billing rules for 21436
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU29.54 · 55%
- Practice expense (office) RVU19.00 · 35%
- Malpractice RVU5.49 · 10%
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.
21436 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Use 21435 when the complicated repair uses an intracranial approach; use 21436 for multiple approaches with internal fixation.
No office rate
Code 21432 describes open repair with wiring of the dentition or fixation, rather than the complex multiple-approach repair with internal fixation represented by 21436.
No office rate
Code 21431 is for closed treatment of a LeFort III-type separation; 21436 is an open, complex repair using multiple approaches and internal fixation.
Compare 21436 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
$1645.74
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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 21436 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,981
- Code
- 21436
- Physician work
- 29.54
- Practice expense
- 19.00
- Malpractice
- 5.49
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 29.54 | × 1.000 | 29.5400 |
| Practice expense | 19.00 | × 0.875 | 16.6250 |
| Malpractice | 5.49 | × 0.566 | 3.1073 |
| Total RVUs | 49.2723 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$1645.74
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 29.54 | 1 |
| Practice expense | 19 | 0.875 |
| Malpractice | 5.49 | 0.566 |
(29.54 × 1 + 19 × 0.875 + 5.49 × 0.566) × $33.4009 = $1645.74
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.
21436 billing questions
What distinguishes this code from 21433?
This code represents the multiple-approach repair with internal fixation. Use 21433 for the comparable complicated, multiple-approach repair when the service does not include internal fixation.
How does this differ from 21435?
Code 21435 identifies a complicated repair using an intracranial approach. This code identifies a multiple-approach repair with internal fixation.
Can the surgeon report assistant-at-surgery or co-surgeon services?
CMS lists assistant-at-surgery payment as available and permits co-surgeons for this code. Team surgery billing is not permitted.
What documentation supports selecting this level?
The operative report should establish the LeFort III-type craniofacial separation, the multiple surgical approaches used, and the internal fixation performed.
How does the 90-day global period affect postoperative care?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
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.
1,97821432,,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
1,98321445,,Optx mndblr/max alv ridge fx,A,,6.10,15.76,,10.18,,0.69,22.55,16.97,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98421450,,Cltx mndblr fx w/o mnpj,A,,3.62,13.87,,9.74,,0.41,17.90,13.77,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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