Billing code 21255: Jaw reconstructionMedicare rate & RVUs in Delaware
Reports reconstructive surgery to restore lower-jaw bone anatomy, such as repair of a mandibular defect following trauma or disease.
CMS doesn’t publish an office rate for 21255 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 21255 covers
This service reconstructs bone of the mandible to address a defect or deformity affecting the lower jaw. Typical clinical situations include restoring mandibular bone after traumatic injury or disease-related bone loss. Oral and maxillofacial surgeons and other reconstructive surgeons may perform the operation in a hospital or ambulatory surgical setting. The operative report should identify the mandibular site, the defect and its cause, and the reconstructive work performed.
Select this code when the documented service is reconstruction of lower-jaw bone, rather than a separately described grafting procedure or surgery directed at the jaw joint. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery 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.
21255 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,208.95 |
How the 21255 rate is calculated
Each of 21255’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 · 21255
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.00Practice expense 15.95Malpractice 2.61
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21255
21255 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21255
Jaw 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 · 21255
Jaw 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
21255 without 50 · national facility
$1,221.14
Jaw reconstruction
21255-50 · Bilateral: 150%
$1,831.71
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).
21255 compared with similar codes
Compare codes
21255 vs 21215 vs 21244 vs 21247 vs 21240: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21215Bone graft
- 21215 describes mandibular bone grafting. Use 21255 when the documented service is reconstruction of lower-jaw bone rather than grafting alone.
- 21244Jaw reconstruction
- Both concern mandibular reconstruction, but 21244 has a distinct procedure description. Compare that description with the operative technique before selecting a code.
- 21247Lower jaw reconstruction
- This is another lower-jaw reconstruction code with a distinct specified service. Choose based on the procedure documented, not the shared anatomic area.
- 21240Jaw joint reconstruction
- 21240 addresses reconstruction of the temporomandibular joint. This code describes reconstruction of lower-jaw bone rather than surgery directed at the joint.
21255 billing questions
How is this different from mandibular bone grafting?
This code describes reconstruction of lower-jaw bone. Code 21215 is for mandibular bone grafting; choose based on the specific service documented and the applicable full code description.
What documentation supports reporting this code?
The operative report should describe the mandibular defect, its location and cause, and the reconstruction performed. Include the relevant technique and materials when documented.
Does the 90-day global period include postoperative care?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
How should bilateral surgery be reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure 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 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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