Billing code 21454: Mandibular fracture repairMedicare rate & RVUs in Alaska
Report 21454 for open surgical treatment of a mandibular fracture when the fracture is reduced and stabilized with an external fixation device.
CMS doesn’t publish an office rate for 21454 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 21454 covers
An oral and maxillofacial surgeon or other facial trauma surgeon uses an open approach to reduce a broken mandible and stabilize it with an external fixation device. The device uses fixation points secured to bone and a frame outside the face to hold the fracture in position. This approach may be selected when the surgeon determines external stabilization is appropriate for the fracture and patient. The service is generally performed in a hospital or other surgical facility.
Report 21454 when the operative documentation supports open treatment and external fixation, rather than percutaneous treatment or another fixation method. The note should identify the mandibular fracture, describe the open approach and reduction, and document the external fixation used. 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 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon payment requires supporting documentation. 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.
21454 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $570.11 |
How the 21454 rate is calculated
Each of 21454’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 · 21454
RVUs × geographic indexes × conversion factor
Work7.18
7.18 RVUs× 1.000 GPCI
Practice expense5.49
5.49 RVUs× 1.000 GPCI
Malpractice0.82
0.82 RVUs× 1.000 GPCI
Adjusted RVUs
13.4900
Conversion factor
$33.4009
Medicare rate
$450.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21454
21454 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21454
Mandibular fracture repair
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 21454
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21454 without 51 · national facility
$450.58
Mandibular fracture repair
21454-51 · Second procedure: 50%
$225.29
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%).
21454 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21452External fixation
- Both involve external fixation, but 21454 is open treatment and 21452 is percutaneous treatment. Follow the operative approach documented.
- 21461Mandibular fracture repair
- 21461 describes open mandibular fracture treatment without interdental fixation. Use 21454 when the documented stabilization is external fixation.
- 21462Mandibular fracture repair
- 21462 describes open treatment with interdental fixation. 21454 identifies open treatment using an external fixation device.
- 21470Mandibular fracture repair
- 21470 is for complicated mandibular fractures treated through multiple surgical approaches. 21454 identifies open treatment with external fixation.
21454 billing questions
How does 21454 differ from 21452?
21454 describes open treatment with external fixation. 21452 is for percutaneous treatment with external fixation, so the documented surgical approach distinguishes them.
When should 21454 be chosen over 21461 or 21462?
Use 21454 when the mandible is treated through an open approach and stabilized externally. Codes 21461 and 21462 distinguish open treatment without or with interdental fixation.
Does the 90-day global period include postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be reported for fractures on both sides?
No. Modifier 50 is inappropriate for this code under the CMS bilateral rule.
When is an assistant surgeon payable?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment also requires supporting documentation, and team surgery is not permitted.
What documentation supports reporting 21454?
Document the mandibular fracture, the open approach and reduction, and the external fixation used to stabilize it. The operative note should make the approach and fixation method clear.
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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