No office rate
Choose 21242 for reconstruction with autogenous bone and cartilage; 21243 is for an alloplastic condylar reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
21242 Jaw joint reconstruction Medicare reimbursement rates in Connecticut
Rebuilds a damaged or absent mandibular condyle using the patient’s bone and cartilage, commonly for major temporomandibular joint defects. Compare 21242 office and facility rates across CMS payment localities in Connecticut.
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 21242 in Connecticut?
Connecticut 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
$976.35
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 21242: Mandibular condyle reconstruction with autogenous graft
Rebuilds a damaged or absent mandibular condyle using the patient’s bone and cartilage, commonly for major temporomandibular joint defects.
This operation rebuilds the mandibular condyle, the jaw’s joint-forming portion, with the patient’s bone and cartilage. A costochondral graft is a familiar approach. Oral and maxillofacial or other qualified surgeons may perform it for major condylar loss associated with trauma, ankylosis, congenital deformity, or destructive disease, usually in a hospital operating room.
Report the code when the reconstruction uses autogenous bone and cartilage; an alloplastic condylar reconstruction is distinguished by 21243. The operative report should identify the defect, side, reconstructive method, and graft material and source. The 90-day global period includes the day-before preoperative visit and related postoperative care. With another procedure in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21242
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.23 · 51%
- Practice expense (office) RVU11.35 · 41%
- Malpractice RVU2.06 · 7%
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.
21242 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
21240 represents temporomandibular joint arthroplasty. 21242 is the more specific choice when the mandibular condyle is rebuilt with a bone-and-cartilage graft.
No office rate
21244 concerns reconstruction of the lower jaw, while 21242 concerns rebuilding the joint-forming mandibular condyle.
Compare 21242 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$976.35
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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 21242 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
1,921
- Code
- 21242
- Physician work
- 14.23
- Practice expense
- 11.35
- Malpractice
- 2.06
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.23 | × 1.020 | 14.5146 |
| Practice expense | 11.35 | × 1.077 | 12.2239 |
| Malpractice | 2.06 | × 1.210 | 2.4926 |
| Total RVUs | 29.2311 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$976.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.23 | 1.02 |
| Practice expense | 11.35 | 1.077 |
| Malpractice | 2.06 | 1.21 |
(14.23 × 1.02 + 11.35 × 1.077 + 2.06 × 1.21) × $33.4009 = $976.35
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.
21242 billing questions
How does 21242 differ from 21243?
21242 represents condylar reconstruction using the patient’s bone and cartilage. 21243 is the related option for reconstruction with alloplastic material.
When would 21240 be considered instead?
21240 describes temporomandibular joint arthroplasty. Consider the distinction between joint surgery that reshapes or treats the joint and a reconstruction that replaces the condylar structure with a bone-and-cartilage graft.
What documentation supports 21242?
Document the condylar defect and its cause, the side treated, the reconstructive work, and use and source of the autogenous bone and cartilage graft.
How is bilateral reconstruction reported?
CMS identifies this as a bilateral procedure; reporting modifier 50 is paid at 150%. Document the work performed on each side.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, while team surgery is not permitted under the CMS facts 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.
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.
1,91821230,,Rib cartilage graft,A,,10.89,7.11,NA,7.11,,1.75,19.75,19.75,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91921235,,Ear cartilage graft,A,,7.31,13.74,,6.82,,1.02,22.07,15.15,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92021240,,Reconstruction of jaw joint,A,,15.67,10.48,NA,10.48,,2.10,28.25,28.25,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92121242,,Reconstruction of jaw joint,A,,14.23,11.35,NA,11.35,,2.06,27.64,27.64,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92221243,,Reconstruction of jaw joint,A,,23.92,16.40,NA,16.40,,3.28,43.60,43.60,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92321244,,Reconstruction of lower jaw,A,,13.28,11.65,NA,11.65,,1.94,26.87,26.87,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92421245,,Reconstruction of jaw,A,,12.79,23.87,,11.31,,1.85,38.51,25.95,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808