Billing code 21243: Joint reconstructionMedicare rate & RVUs in Delaware
Rebuilds the temporomandibular joint with alloplastic material, typically for severe joint damage when prosthetic reconstruction is performed.
CMS doesn’t publish an office rate for 21243 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 21243 covers
This operation reconstructs the mandibular condyle and temporomandibular joint using alloplastic material, such as prosthetic joint components. Oral and maxillofacial surgeons commonly perform it for major joint destruction, ankylosis, or other conditions requiring prosthetic reconstruction, often in a hospital or ambulatory surgical setting. The operative report should identify the joint treated, the condition prompting reconstruction, and the alloplastic reconstruction performed.
Report this code when the surgeon reconstructs the TMJ with alloplastic material, rather than performing joint arthroplasty without that material or reconstruction with an autogenous graft. The procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services may be paid; co-surgeons are paid only with supporting documentation, and 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.
21243 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,442.64 |
How the 21243 rate is calculated
Each of 21243’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 · 21243
RVUs × geographic indexes × conversion factor
Work23.92
23.92 RVUs× 1.000 GPCI
Practice expense16.40
16.40 RVUs× 1.000 GPCI
Malpractice3.28
3.28 RVUs× 1.000 GPCI
Adjusted RVUs
43.6000
Conversion factor
$33.4009
Medicare rate
$1,456.28
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21243
21243 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21243
Joint 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 21243
Joint 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 50 · payment effect
With and without the modifier
21243 without 50 · national facility
$1,456.28
Joint reconstruction
21243-50 · Bilateral: 150%
$2,184.42
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21243 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21240Jaw joint reconstruction
- 21240 describes TMJ arthroplasty without the alloplastic reconstruction represented by this code. Choose based on the actual joint procedure documented.
- 21242Jaw joint reconstruction
- 21242 is the related TMJ reconstruction code for an autogenous graft; this code is for reconstruction with alloplastic material.
- 21244Jaw reconstruction
- 21244 addresses reconstruction of the mandible rather than reconstruction of the temporomandibular joint with alloplastic material.
21243 billing questions
How does this differ from 21242?
This code describes TMJ reconstruction using alloplastic material. Code 21242 is the related reconstruction option using an autogenous graft.
When is 21240 a better fit?
Use 21240 for TMJ arthroplasty without the alloplastic reconstruction described by this code. The operative report should support which procedure was performed.
How should bilateral reconstruction be reported?
For bilateral procedures, report modifier 50; CMS pays the bilateral procedure at 150%.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What should the operative note establish?
Document the TMJ treated, the condition requiring reconstruction, and that alloplastic material was used to reconstruct the joint.
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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