$496.79
Use 21040 for mandibular benign cyst or tumor removal by enucleation and curettage. Choose 21046 when the documented procedure requires intraoral osteotomy.
On this page
CMS RVU26D · Effective 2026-10-01
21046 Mandibular lesion excision Medicare reimbursement rates in Colorado
Reports removal of a benign mandibular cyst or tumor when intraoral osteotomy is required to access and excise the lesion. Compare 21046 office and facility rates across CMS payment localities in Colorado.
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 21046 in Colorado?
Colorado 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
$916.36
1 of 1 localities have a supported rate.
Payment area: Colorado
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 21046: Mandibular cyst or tumor excision with osteotomy
Reports removal of a benign mandibular cyst or tumor when intraoral osteotomy is required to access and excise the lesion.
This code describes operative removal of a benign cyst or tumor in the mandible when the surgeon must perform an osteotomy through an intraoral approach to reach or remove it. Oral and maxillofacial surgeons commonly perform the procedure for jaw lesions that cannot be managed by simple enucleation and curettage. The operative report should establish the lesion’s mandibular location and explain the osteotomy and excision performed.
Choose this code based on the documented surgical work and approach, not lesion size alone. A simpler enucleation-and-curettage procedure may fit 21040, while an extraoral osteotomy or resection may point to 21047. 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 and co-surgeon payment require supporting documentation; team surgery is not permitted.
CMS billing rules for 21046
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.85 · 51%
- Practice expense (office) RVU11.32 · 42%
- Malpractice RVU1.76 · 7%
850
Medicare services in 2024 · #3095 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.
21046 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Both concern benign mandibular cysts or tumors, but 21047 describes work requiring an extraoral osteotomy and/or resection rather than the intraoral approach in 21046.
No office rate
21048 concerns a benign cyst or tumor in the maxilla requiring intraoral osteotomy; 21046 is for the mandible.
Compare 21046 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
Colorado →
Office / nonfacility
Unavailable
Facility
$916.36
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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 21046 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
1,853
- Code
- 21046
- Physician work
- 13.85
- Practice expense
- 11.32
- Malpractice
- 1.76
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.85 | × 1.012 | 14.0162 |
| Practice expense | 11.32 | × 1.064 | 12.0445 |
| Malpractice | 1.76 | × 0.781 | 1.3746 |
| Total RVUs | 27.4352 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$916.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.85 | 1.012 |
| Practice expense | 11.32 | 1.064 |
| Malpractice | 1.76 | 0.781 |
(13.85 × 1.012 + 11.32 × 1.064 + 1.76 × 0.781) × $33.4009 = $916.36
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.
21046 billing questions
When should 21046 be selected instead of 21040?
Use 21046 when the operative work requires intraoral osteotomy to access or remove the mandibular lesion. 21040 describes removal by enucleation and curettage without that level of approach.
How does 21046 differ from 21047?
21046 describes the intraoral osteotomy approach. 21047 is the neighboring mandibular code for a lesion requiring extraoral osteotomy and/or resection.
What documentation supports 21046?
Document the benign cyst or tumor’s mandibular location, the intraoral approach, the osteotomy performed, and the excision. The operative note should make clear why simple enucleation and curettage was insufficient.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this code; report the service based on the mandibular lesion and work performed.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. Separately reportable care must be outside those included services.
When may an assistant or co-surgeon be paid?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation, and 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.
1,85021040,,Excise mandible lesion,A,,4.79,8.99,,4.73,,0.59,14.37,10.11,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85121044,,Removal of jaw bone lesion,A,,12.48,8.57,NA,8.57,,1.85,22.90,22.90,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85221045,,Extensive jaw surgery,A,,17.91,11.15,NA,11.15,,2.71,31.77,31.77,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85321046,,Remove mandible cyst complex,A,,13.85,11.32,NA,11.32,,1.76,26.93,26.93,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85421047,,Excise lwr jaw cyst w/repair,A,,19.57,10.05,NA,10.05,,2.61,32.23,32.23,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85521048,,Remove maxilla cyst complex,A,,14.34,11.05,NA,11.05,,1.76,27.15,27.15,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85621049,,Excis uppr jaw cyst w/repair,A,,18.84,9.27,NA,9.27,,2.46,30.57,30.57,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899