Billing code 21490: TMJ dislocationMedicare rate & RVUs in Florida
Reports operative open management of a dislocated temporomandibular joint when the surgeon treats the displacement through an open surgical approach.
CMS doesn’t publish an office rate for 21490 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 21490 covers
billing code 21490 represents open operative treatment of a temporomandibular joint dislocation. The surgeon accesses the joint surgically to manage the displaced mandibular condyle. Oral and maxillofacial surgeons and other surgeons with relevant facial-joint expertise may perform this procedure, generally in an operating-room setting. The defining distinction is the open approach, rather than reduction by closed manipulation.
Choose this code when the operative record supports open treatment of the TMJ dislocation; document the affected joint, the dislocation, and the open surgical work performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. 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 21490 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 | $755.47 |
| Miami | Unavailable | $796.97 |
| Rest Of Florida | Unavailable | $726.92 |
How the 21490 rate is calculated
Each of 21490’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 · 21490
RVUs × geographic indexes × conversion factor
Work12.63
12.63 RVUs× 1.000 GPCI
Practice expense7.29
7.29 RVUs× 1.000 GPCI
Malpractice1.44
1.44 RVUs× 1.000 GPCI
Adjusted RVUs
21.3600
Conversion factor
$33.4009
Medicare rate
$713.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21490
21490 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21490
TMJ dislocation
| 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 · 21490
TMJ dislocation
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
21490 without 50 · national facility
$713.44
TMJ dislocation
21490-50 · Bilateral: 150%
$1,070.16
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).
21490 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21480TMJ dislocation treatment
- 21480 is for closed treatment of a TMJ dislocation. Use 21490 when the surgeon treats the dislocation through an open operative approach.
- 21485TMJ reduction
- 21485 describes closed treatment of a complicated TMJ dislocation; 21490 describes open treatment. The operative approach distinguishes these codes.
- 21499Unlisted muscskel px head
- 21499 is an unlisted head musculoskeletal procedure code. Use a specific code such as 21490 when it accurately describes the open TMJ dislocation treatment.
21490 billing questions
How does 21490 differ from 21480?
21490 is for open operative treatment of the TMJ dislocation. 21480 describes closed treatment, so use it when the dislocation is managed without an open approach.
When should 21485 be considered instead?
21485 describes closed treatment of a complicated TMJ dislocation. It is not the open-treatment code; choose based on the approach and the documented procedure.
What documentation supports 21490?
The operative report should identify the TMJ dislocation, the joint treated, the open approach, and the operative work performed to manage the displacement.
How does Medicare handle bilateral reporting?
The CMS payment rule lists bilateral reporting with modifier 50 at 150%. Document treatment of both joints and report the modifier according to applicable claim instructions.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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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