CPT code 21194: Mandible reconstruction2026 Medicare rate & RVUs in Florida
Reports reconstruction of the lower jaw using a bone graft to restore a mandibular defect, such as one remaining after tumor removal or trauma.
CMS doesn’t publish an office rate for 21194 in Florida.
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 21194 covers
This service reconstructs a defect in the mandible using a bone graft to restore lower-jaw continuity or contour. Oral and maxillofacial surgeons and plastic surgeons may perform it for defects related to trauma, tumor removal, or congenital conditions. The procedure is generally performed in an operating room, with the operative report identifying the mandibular defect and describing the graft reconstruction.
Select this code when the documented reconstruction uses a bone graft; distinguish it from lower-jaw reconstruction without a graft and from variants defined by fixation or segmental work. The record should support the defect treated and the reconstructive technique performed. Medicare 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 other procedures are subject to the standard 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeons and team surgery are 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.
Where 21194 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $1,368.51 |
| Miami | Unavailable | $1,455.50 |
| Rest Of Florida | Unavailable | $1,310.64 |
How the 21194 rate is calculated
Each of 21194’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 · 21194
RVUs × geographic indexes × conversion factor
Work21.27
21.27 RVUs× 1.000 GPCI
Practice expense13.97
13.97 RVUs× 1.000 GPCI
Malpractice3.07
3.07 RVUs× 1.000 GPCI
Adjusted RVUs
38.3100
Conversion factor
$33.4009
Medicare rate
$1,279.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21194
21194 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21194
Mandible 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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 21194
Mandible 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
21194 without 51 · national facility
$1,279.59
Mandible reconstruction
21194-51 · Second procedure: 50%
$639.80
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%).
21194 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21193Mandibular reconstruction
- Use 21194 when the mandibular reconstruction uses a bone graft; 21193 describes the no-graft approach.
- 21195Jaw reconstruction
- 21195 is identified as lower-jaw reconstruction without fixation, rather than the graft-based reconstruction described by 21194.
- 21196Mandibular reconstruction
- 21196 is identified as lower-jaw reconstruction with fixation. Choose 21194 when the defining service is reconstruction with a bone graft.
21194 billing questions
How is this code distinguished from 21193?
This code describes mandibular reconstruction with a bone graft. Code 21193 is the corresponding lower-jaw reconstruction without a graft.
Does modifier 50 increase Medicare payment?
No. CMS prices this code as bilateral, and modifier 50 does not increase payment.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment may be made. CMS does not permit co-surgeons or team surgery for this code.
How are other procedures performed in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What should the operative report document?
Document the mandibular defect and the use of a bone graft to reconstruct it. The details should make clear why the graft-based service, rather than a no-graft or fixation-defined variant, was performed.
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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