No office rate
Choose 21242 for condylar reconstruction with a bone graft; 21240 describes reconstruction using autogenous material such as fascia or muscle.
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CMS RVU26D · Effective 2026-10-01
21240 Jaw joint reconstruction Medicare reimbursement rates in Delaware
Reconstructs the mandibular condyle using the patient’s own tissue, such as fascia or muscle, when the jaw joint requires surgical restoration. Compare 21240 office and facility rates across CMS payment localities in Delaware.
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 21240 in Delaware?
Delaware 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
$934.91
1 of 1 localities have a supported rate.
Payment area: Delaware
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 21240: Mandibular condyle reconstruction with autogenous material
Reconstructs the mandibular condyle using the patient’s own tissue, such as fascia or muscle, when the jaw joint requires surgical restoration.
This operation restores the mandibular condyle, the part of the lower jaw that meets the skull at the temporomandibular joint, using tissue from the patient. An oral and maxillofacial or craniofacial surgeon may perform it when the condyle has been lost, damaged, or deformed, such as after trauma or removal of diseased tissue. The autogenous material may include fascia, muscle, or a temporalis flap. The service is generally performed in an operating room rather than an office setting.
Select 21240 when the reconstruction uses autogenous material rather than a bone graft or an alloplastic joint component. The operative report should identify the condylar defect and the tissue used to reconstruct it. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21240
- 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 RVU15.67 · 55%
- Practice expense (office) RVU10.48 · 37%
- Malpractice RVU2.10 · 7%
122
Medicare services in 2024 · #4721 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.
21240 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Choose 21243 when an alloplastic component is used to reconstruct the condyle. Code 21240 describes an autogenous-material reconstruction.
No office rate
21244 addresses reconstruction of the mandible, not reconstruction specifically directed at the mandibular condyle.
Compare 21240 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
Delaware →
Office / nonfacility
Unavailable
Facility
$934.91
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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 21240 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,920
- Code
- 21240
- Physician work
- 15.67
- Practice expense
- 10.48
- Malpractice
- 2.10
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.67 | × 1.005 | 15.7483 |
| Practice expense | 10.48 | × 0.988 | 10.3542 |
| Malpractice | 2.10 | × 0.899 | 1.8879 |
| Total RVUs | 27.9905 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$934.91
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.67 | 1.005 |
| Practice expense | 10.48 | 0.988 |
| Malpractice | 2.1 | 0.899 |
(15.67 × 1.005 + 10.48 × 0.988 + 2.1 × 0.899) × $33.4009 = $934.91
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.
21240 billing questions
How does 21240 differ from 21242?
21240 describes condylar reconstruction using autogenous material such as fascia or muscle. 21242 is the bone-graft reconstruction option.
How does 21240 differ from 21243?
Use 21243 when the condyle is reconstructed with alloplastic material. 21240 is the autogenous-material approach.
What should the operative report document?
Document the condylar defect or damage, the reconstruction performed, and the autogenous tissue used. These details distinguish 21240 from bone-graft and alloplastic reconstruction.
Does the 90-day global period include postoperative visits?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the major-surgery global period.
Can 21240 be reported bilaterally?
CMS lists bilateral reporting with modifier 50, paid at 150%. The record should support reconstruction of both condyles.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; CMS does not permit team surgery.
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.
1,91721215,,Lower jaw bone graft,A,,11.92,110.02,,8.24,,1.41,123.35,21.57,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503