No office rate
Use 21431 for closed treatment without manipulation. Use 21432 when treatment is open and includes wiring of facial bones.
On this page
CMS RVU26D · Effective 2026-10-01
21431 Fracture treatment Medicare reimbursement rates in Connecticut
Reports closed management of a LeFort III craniofacial separation when the fracture is treated without manipulation or open surgical exposure. Compare 21431 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 21431 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
$686.04
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.
Craniofacial surgery
About 21431: Closed craniofacial separation treatment
Reports closed management of a LeFort III craniofacial separation when the fracture is treated without manipulation or open surgical exposure.
This service covers closed management of a LeFort III injury, in which the midface is separated from the cranial base, without manipulating the fracture. It may be provided by an oral and maxillofacial surgeon, plastic surgeon, otolaryngologist, or trauma surgeon caring for a patient with severe facial trauma. The defining distinction is the closed, nonmanipulative treatment approach, rather than open exposure and repair.
Report 21431 when the documented treatment matches that approach; documentation should identify the craniofacial separation and the closed method used. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid. Modifier 50 is inappropriate; co-surgeons and team surgery are not permitted.
CMS billing rules for 21431
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.70 · 40%
- Practice expense (office) RVU10.79 · 56%
- Malpractice RVU0.88 · 5%
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.
21431 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
21433 describes open treatment of a complicated craniofacial separation using multiple approaches; 21431 is closed treatment without manipulation.
No office rate
21422 addresses open treatment of a palatal or maxillary fracture. 21431 is for closed treatment of a LeFort III craniofacial separation.
Compare 21431 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
$686.04
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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 21431 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
1,977
- Code
- 21431
- Physician work
- 7.70
- Practice expense
- 10.79
- Malpractice
- 0.88
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.70 | × 1.020 | 7.8540 |
| Practice expense | 10.79 | × 1.077 | 11.6208 |
| Malpractice | 0.88 | × 1.210 | 1.0648 |
| Total RVUs | 20.5396 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$686.04
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.7 | 1.02 |
| Practice expense | 10.79 | 1.077 |
| Malpractice | 0.88 | 1.21 |
(7.7 × 1.02 + 10.79 × 1.077 + 0.88 × 1.21) × $33.4009 = $686.04
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.
21431 billing questions
How does 21431 differ from 21432?
21431 is for closed treatment without manipulation. 21432 describes open treatment with wiring of the facial bones.
What documentation supports 21431?
Document the LeFort III craniofacial separation and the closed treatment approach, including that the fracture was treated without manipulation.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate 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.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
How does the multiple-procedure rule affect payment?
When 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.
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.
1,97421421,,Cltx palatal/max fx wire fix,A,,5.87,13.23,,8.85,,0.66,19.76,15.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97521422,,Optx palatal/max fracture,A,,8.51,7.92,NA,7.92,,1.24,17.67,17.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97621423,,Optx palatal/max fx comp,A,,10.58,9.07,NA,9.07,,1.96,21.61,21.61,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97721431,,Cltx craniofacial separation,A,,7.70,10.79,NA,10.79,,0.88,19.37,19.37,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97821432,,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
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