Billing code 21146: Midface reconstructionMedicare rate & RVUs in Delaware
Reports LeFort I midface reconstruction when the maxilla is divided into two segments and bone grafting is part of the reconstruction.
CMS doesn’t publish an office rate for 21146 in Delaware.
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 21146 covers
This procedure reconstructs the midface through a LeFort I approach, mobilizing and repositioning the maxilla as two segments and incorporating bone graft. Oral and maxillofacial surgeons and craniofacial or plastic surgeons typically perform it in an operating room for selected maxillary deformities requiring segmental reconstruction. The operative report should support the LeFort I level, two-piece configuration, and grafting performed.
Select this code when the reconstruction uses two maxillary segments with bone graft; the segment count and graft distinguish it from nearby LeFort I codes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. 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. Assistant-at-surgery services may be paid; 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.
21146 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,438.84 |
How the 21146 rate is calculated
Each of 21146’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 · 21146
RVUs × geographic indexes × conversion factor
Work24.25
24.25 RVUs× 1.000 GPCI
Practice expense15.74
15.74 RVUs× 1.000 GPCI
Malpractice3.51
3.51 RVUs× 1.000 GPCI
Adjusted RVUs
43.5000
Conversion factor
$33.4009
Medicare rate
$1,452.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21146
21146 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21146
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) | 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 · 21146
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
21146 without 51 · national facility
$1,452.94
Midface reconstruction
21146-51 · Second procedure: 50%
$726.47
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%).
21146 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21142Le Fort I reconstruction
- Both are two-piece LeFort I reconstructions; 21146 includes bone grafting, while 21142 is the corresponding code without graft.
- 21145LeFort I reconstruction
- Both include bone grafting at the LeFort I level. Choose 21145 for a one-piece configuration and 21146 for two pieces.
- 21147Midface reconstruction
- Both include bone grafting at the LeFort I level. 21147 is for three or more pieces; 21146 is for two.
- 21143LeFort I reconstruction
- Both describe LeFort I reconstruction in three or more pieces. 21143 is without graft; 21146 is a two-piece reconstruction with graft.
21146 billing questions
How does this differ from 21142?
Both describe a two-piece LeFort I reconstruction. This code includes bone grafting; 21142 describes the two-piece configuration without grafting.
How does this differ from 21145?
Both include grafting, but 21145 is for a one-piece LeFort I reconstruction. Use this code when the maxilla is reconstructed in two segments.
When is 21147 a better fit?
Use 21147 when the grafted LeFort I reconstruction divides the maxilla into three or more pieces. The operative documentation should establish the segment count.
Is related postoperative care separately reported?
The 90-day global period includes related postoperative care and the day-before preoperative visit. The global period begins with the surgery.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be available. 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 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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