Billing code 21470: Mandibular fracture repairMedicare rate & RVUs in Florida
Reports open surgical repair of a complicated mandibular fracture when operative reduction and stabilization are required for the injury.
CMS doesn’t publish an office rate for 21470 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 21470 covers
This service covers open surgical management of a complicated fracture of the mandible, involving access to the fracture, realignment, and stabilization. It is typically performed by an oral and maxillofacial surgeon or another surgeon experienced in facial trauma in an operating room, often after significant facial injury. The repair may involve one or more fracture sites and may include fixation appropriate to the documented pattern and operative plan.
Report the code when the operative record supports a complicated mandibular fracture treated through an open approach; document the fracture pattern and sites, surgical exposure, reduction, and stabilization. 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 others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeons require 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 21470 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 | $1,113.50 |
| Miami | Unavailable | $1,185.87 |
| Rest Of Florida | Unavailable | $1,065.60 |
How the 21470 rate is calculated
Each of 21470’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 · 21470
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.10Practice expense 11.46Malpractice 2.56
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21470
21470 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21470
Mandibular fracture repair
| 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 · 21470
Mandibular fracture repair
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
21470 without 51 · national facility
$1,039.44
Mandibular fracture repair
21470-51 · Second procedure: 50%
$519.72
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%).
21470 compared with similar codes
Compare codes
21470 vs 21461 vs 21462 vs 21454 vs 21465: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21461Mandibular fracture repair
- 21461 describes open treatment of a mandibular fracture without interdental fixation and without the complicated designation. Choose 21470 when the operative documentation supports a complicated fracture.
- 21462Mandibular fracture repair
- 21462 is for open mandibular fracture treatment with interdental fixation, without the complicated designation. The complicated fracture characterization distinguishes 21470.
- 21454Mandibular fracture repair
- 21454 describes open treatment using external fixation. Select 21470 for the complicated fracture service when external fixation is not the defining treatment distinction.
- 21465Mandibular fracture repair
- 21465 is specific to open treatment of a mandibular condylar fracture. Use 21470 for a complicated mandibular fracture outside that condylar-specific service.
21470 billing questions
How does this differ from 21461 or 21462?
Use 21470 when the mandibular fracture is documented and treated as complicated. Codes 21461 and 21462 describe open treatment of mandibular fractures without the complicated designation and distinguish whether interdental fixation is used.
Is routine postoperative care separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Should modifier 50 be appended for fractures on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting the complicated-fracture code?
Document the fracture sites and pattern, why the injury is considered complicated, the open surgical approach, and the reduction and stabilization 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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