Billing code 21188: Midface reconstructionMedicare rate & RVUs in Alaska
Midface reconstruction covers major surgical reconstruction of the central facial skeleton, reported when the operative plan and documented work support this specific procedure.
CMS doesn’t publish an office rate for 21188 in Alaska.
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 9 sections
What 21188 covers
This major reconstructive operation addresses the bony framework of the midface, such as the maxillary and cheek-region structures. It may be performed for a congenital craniofacial deformity, significant facial trauma, or a defect after removal of diseased tissue. Craniofacial, oral and maxillofacial, and plastic surgeons commonly perform this work in an operating room. The operative report should identify the reconstructed anatomy and describe the surgical approach and any grafting or other reconstruction performed.
Report 21188 when the documented midface reconstruction matches this procedure rather than a separately defined LeFort reconstruction or a lower-jaw procedure. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be allowed; 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.
21188 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $1,793.56 |
How the 21188 rate is calculated
Each of 21188’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 · 21188
RVUs × geographic indexes × conversion factor
Work22.57
22.57 RVUs× 1.000 GPCI
Practice expense16.94
16.94 RVUs× 1.000 GPCI
Malpractice3.27
3.27 RVUs× 1.000 GPCI
Adjusted RVUs
42.7800
Conversion factor
$33.4009
Medicare rate
$1,428.89
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21188
21188 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21188
Midface reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21188
Midface reconstruction
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21188 without 51 · national facility
$1,428.89
Midface reconstruction
21188-51 · Second procedure: 50%
$714.45
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%).
21188 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21154Midface reconstruction
- 21154 identifies a LeFort III reconstruction without a LeFort I procedure. Select between it and 21188 by matching the documented operation to the specific code definition.
- 21155Midface reconstruction
- 21155 identifies a LeFort III reconstruction with a LeFort I procedure. The operative report should establish whether that defined combination was performed.
- 21193Mandibular reconstruction
- 21193 is for lower-jaw reconstruction without graft; 21188 concerns the midface. The reconstructed bone site determines which code family to consider.
21188 billing questions
How should 21188 be distinguished from the LeFort reconstruction codes?
Use the code whose defined procedure matches the operative work. The LeFort codes identify specific LeFort levels and, in some cases, grafting or advancement details; the operative report must support the selected procedure.
Can modifier 50 be appended for reconstruction on both sides?
No. CMS identifies bilateral adjustment as inappropriate for 21188, so modifier 50 is not the right way to report bilateral work.
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 surgeon be reported?
Assistant-at-surgery payment may be allowed for 21188. Co-surgeons and team surgery are not permitted under the CMS rules supplied for this code.
How is 21188 paid when another procedure is performed in the same session?
Under the standard multiple-procedure rule, 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 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
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