Billing code 21198: Jaw reconstructionMedicare rate & RVUs in Florida
Reports surgical reconstruction of a segment of the lower jaw, such as when a mandibular defect requires segment-focused repair rather than jaw advancement.
CMS doesn’t publish an office rate for 21198 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 21198 covers
This operation reconstructs a segment of the mandible to restore jaw continuity or contour. Oral and maxillofacial surgeons and other reconstructive surgeons may perform it in a hospital operating room for a defect related to trauma, tumor removal, or another condition requiring segmental repair. The operative report should identify the mandibular segment reconstructed and describe the work performed; the code is not selected merely because the procedure involves the lower jaw.
Report the code when the documented operation is segmental mandibular reconstruction, distinguishing it from the separate lower-jaw reconstruction approaches represented by 21193–21196 and from advancement under 21199. The procedure has 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 other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires 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.
Where 21198 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 | $967.37 |
| Miami | Unavailable | $1,025.02 |
| Rest Of Florida | Unavailable | $928.09 |
How the 21198 rate is calculated
Each of 21198’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 · 21198
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.32Practice expense 9.88Malpractice 2.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21198
21198 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21198
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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 21198
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 51 · payment effect
With and without the modifier
21198 without 51 · national facility
$908.84
Jaw reconstruction
21198-51 · Second procedure: 50%
$454.42
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%).
21198 compared with similar codes
Compare codes
21198 vs 21193 vs 21194 vs 21199: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21193Mandibular reconstruction
- 21193 describes lower-jaw reconstruction without bone graft. Use 21198 when the operation is documented as segmental reconstruction, rather than selecting by graft status alone.
- 21194Mandible reconstruction
- 21194 describes lower-jaw reconstruction with bone graft. The defining distinction for 21198 is segmental reconstruction; confirm the operative approach rather than relying only on whether a graft was used.
- 21199Mandibular reconstruction
- 21199 is for lower-jaw reconstruction with advancement. 21198 is the segmental reconstruction option, not the advancement approach.
21198 billing questions
How is 21198 distinguished from 21193–21196?
Use the operative description to determine whether the surgeon performed segmental mandibular reconstruction or one of the distinct lower-jaw reconstruction approaches represented by 21193–21196. Do not choose based only on the fact that the mandible was operated on.
When is 21199 a better fit?
21199 describes lower-jaw reconstruction with advancement. Choose 21198 when the documented procedure is segmental reconstruction rather than reconstruction by advancement.
What documentation supports reporting 21198?
Document the mandibular segment reconstructed, the defect or clinical reason for reconstruction, and the operative steps that establish segmental reconstruction. The note should make the distinction from other lower-jaw reconstruction approaches clear.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical episode.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed during the same session.
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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