Billing code 21199: Mandibular reconstructionMedicare rate & RVUs in Georgia
Reports reconstructive surgery that advances the lower jaw to address mandibular deformity, such as a jaw-position problem requiring operative correction.
CMS doesn’t publish an office rate for 21199 in Georgia.
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 21199 covers
This code describes reconstructive surgery that advances the mandible, moving the lower jaw forward as part of correcting its position or form. Oral and maxillofacial surgeons and other surgeons with craniofacial expertise typically perform the operation in a hospital or ambulatory surgical setting. Clinical contexts can include significant mandibular deficiency or deformity associated with congenital or developmental conditions; the operative plan and documented work determine whether advancement reconstruction is the service performed.
Report the code when the documented reconstruction includes advancement of the lower jaw, rather than selecting a related code solely because it involves the mandible. The operative report should identify the deformity, the advancement performed, and the reconstruction’s extent. The service has 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 21199 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $928.23 |
| Rest Of Georgia | Unavailable | $890.88 |
How the 21199 rate is calculated
Each of 21199’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 · 21199
RVUs × geographic indexes × conversion factor
Work16.31
16.31 RVUs× 1.000 GPCI
Practice expense8.45
8.45 RVUs× 1.000 GPCI
Malpractice2.37
2.37 RVUs× 1.000 GPCI
Adjusted RVUs
27.1300
Conversion factor
$33.4009
Medicare rate
$906.17
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21199
21199 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21199
Mandibular 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 · 21199
Mandibular 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
21199 without 51 · national facility
$906.17
Mandibular reconstruction
21199-51 · Second procedure: 50%
$453.09
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%).
21199 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21193Mandibular reconstruction
- 21193 describes lower-jaw reconstruction without graft. Use 21199 when the documented reconstructive work includes advancement.
- 21194Mandible reconstruction
- 21194 describes lower-jaw reconstruction with graft. The advancement feature distinguishes 21199; select based on the actual operative work.
- 21196Mandibular reconstruction
- 21196 describes lower-jaw reconstruction with fixation. Do not substitute it for 21199 when the defining documented service is advancement.
21199 billing questions
How is 21199 distinguished from other lower-jaw reconstruction codes?
The key distinction is that 21199 describes reconstruction with advancement. Compare the operative work with codes describing reconstruction without graft, with graft, or with fixation.
Does modifier 50 apply when both sides of the jaw are treated?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
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 or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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