No office rate
Both involve LeFort III advancement; 21160 is the choice when bone grafting is also performed, while 21159 is for advancement without grafting.
On this page
CMS RVU26D · Effective 2026-10-01
21160 Midface reconstruction Medicare reimbursement rates in Florida
Reports LeFort III advancement of the midface with bone grafting to correct substantial midface retrusion or a related craniofacial deformity. Compare 21160 office and facility rates across CMS payment localities in Florida.
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 21160 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2477.77–$2761.43
3 of 3 localities have a supported rate.
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.
Where 21160 pays more and less in Florida
Craniofacial surgery
About 21160: LeFort III midface advancement with graft
Reports LeFort III advancement of the midface with bone grafting to correct substantial midface retrusion or a related craniofacial deformity.
This operation mobilizes and advances the midface at the LeFort III level, with bone grafting to support the reconstruction. Craniofacial plastic surgeons and oral and maxillofacial surgeons typically perform it in an operating room, often for severe midface retrusion associated with congenital craniofacial conditions or craniosynostosis. The operative record should establish the LeFort III advancement and describe the graft used and its role in the reconstruction.
Select this code when the documented reconstruction includes both LeFort III advancement and bone grafting; distinguish it from related LeFort III procedures based on whether advancement and grafting are performed. CMS assigns a 90-day global period, including 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 others at 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 21160
- 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 RVU46.01 · 64%
- Practice expense (office) RVU18.92 · 26%
- Malpractice RVU6.71 · 9%
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.
21160 compared with similar codes
Office rates for Florida, from the same CMS release.
No office rate
Both include bone grafting at the LeFort III level. Choose 21160 when the documented reconstruction specifically includes advancement.
No office rate
This is a LeFort I reconstruction with bone grafting. Code 21160 represents advancement at the LeFort III level.
Compare 21160 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
Unavailable
Facility
$2582.14
Miami →
Office / nonfacility
Unavailable
Facility
$2761.43
Rest Of Florida →
Office / nonfacility
Unavailable
Facility
$2477.77
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21160 billing questions
How does this differ from 21159?
Both describe LeFort III advancement, but 21160 is the grafted service. Use 21159 when the advancement is performed without bone grafting.
How does this differ from 21155?
21155 describes LeFort III reconstruction with bone grafting without the advancement distinction in 21160. The operative documentation should support the specific procedure performed.
Can the bone graft be reported separately?
Bone grafting is part of the service represented by 21160. Do not separately report the same graft work as though it were a separate reconstruction.
Does modifier 50 apply?
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.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted under the CMS rules provided for this code.
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.
1,89421154,,Rcnstj mdfc lefort iii w/o i,A,,30.51,15.14,NA,15.14,,4.46,50.11,50.11,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89521155,,Rcnstj mdfc lefort iii w/i,A,,34.34,16.08,NA,16.08,,5.01,55.43,55.43,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89621159,,Rcnst mdfc lfrtiii advm wo i,A,,42.06,17.96,NA,17.96,,6.15,66.17,66.17,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89721160,,Rcnst mdfc lfrtiii advm w/i,A,,46.01,18.92,NA,18.92,,6.71,71.64,71.64,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89821172,,Rcnst supr-lat orb rm&lw fhd,A,,27.50,23.42,NA,23.42,,11.63,62.55,62.55,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89921175,,Rcnst bfrnt sp orb rm&lw fhd,A,,32.72,19.04,NA,19.04,,6.08,57.84,57.84,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90021179,,Rcnstj forehead with grafts,A,,22.08,14.03,NA,14.03,,4.10,40.21,40.21,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00