No office rate
61500 describes craniectomy for excision of a benign supratentorial tumor. Use 21181 for the distinct reconstructive contouring work associated with a benign cranial tumor.
On this page
CMS RVU26D · Effective 2026-10-01
21181 Cranial reconstruction Medicare reimbursement rates in Guam
Reconstructs and contours the external cranial bone after treatment of a benign tumor when the resulting bony shape requires surgical correction. Compare 21181 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 21181 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$684.34
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Craniofacial surgery
About 21181: Cranial contour reconstruction after benign tumor
Reconstructs and contours the external cranial bone after treatment of a benign tumor when the resulting bony shape requires surgical correction.
This service addresses contour deformity of the external cranial bones associated with a benign tumor, such as an irregular skull contour after tumor treatment. A craniofacial or plastic surgeon, or a neurosurgeon with reconstructive expertise, reshapes or reconstructs the affected cranial area in an operative setting. The work is directed at the bony contour rather than simply removing the tumor.
Report 21181 when the operation performs the specific cranial contour reconstruction for a benign tumor; documentation should identify the tumor-related deformity, the cranial site, and the reconstructive work performed. Tumor excision is a distinct service and should be evaluated separately when performed. Medicare assigns a 90-day global period, which 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 other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment requires documented medical necessity.
CMS billing rules for 21181
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.02 · 50%
- Practice expense (office) RVU8.26 · 41%
- Malpractice RVU1.86 · 9%
34
Medicare services in 2024 · #5574 by national volume
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.
21181 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
62140 is cranioplasty for a skull defect up to its specified size threshold. 21181 is selected for cranial contour reconstruction associated with a benign tumor.
No office rate
62141 addresses cranioplasty for a skull defect above the size threshold for 62140. It is not the tumor-related contouring service represented by 21181.
Compare 21181 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$684.34
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21181 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,902
- Code
- 21181
- Physician work
- 10.02
- Practice expense
- 8.26
- Malpractice
- 1.86
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.02 | × 1.000 | 10.0200 |
| Practice expense | 8.26 | × 1.137 | 9.3916 |
| Malpractice | 1.86 | × 0.579 | 1.0769 |
| Total RVUs | 20.4886 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$684.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.02 | 1 |
| Practice expense | 8.26 | 1.137 |
| Malpractice | 1.86 | 0.579 |
(10.02 × 1 + 8.26 × 1.137 + 1.86 × 0.579) × $33.4009 = $684.34
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21181 billing questions
Is 21181 for removing the benign cranial tumor?
No. It represents reconstruction and contouring of the external cranial bone related to a benign tumor. Tumor excision is a separate surgical service when performed and should be coded based on the excision performed.
How does 21181 differ from cranioplasty codes 62140 and 62141?
21181 describes tumor-related cranial contour reconstruction. Codes 62140 and 62141 address cranioplasty for a skull defect, with the applicable code selected by the defect-size criteria.
What documentation supports reporting 21181?
The operative report should establish the benign tumor-related cranial deformity, identify the site, and describe the contouring or reconstruction performed.
Does the 90-day global period include routine postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant surgeon be reported?
Medicare pays an assistant at surgery only when the record documents medical necessity.
How are other procedures in the same operative session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,89921175,,Rcnst bfrnt sp orb rm&lw fhd,A,,32.72,19.04,NA,19.04,,6.08,57.84,57.84,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90021179,,Rcnstj forehead with grafts,A,,22.08,14.03,NA,14.03,,4.10,40.21,40.21,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90121180,,Rcnstj forehead w/autograft,A,,24.94,15.21,NA,15.21,,4.63,44.78,44.78,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90221181,,Rcnst cntrg b9 tum crnl xtrc,A,,10.02,8.26,NA,8.26,,1.86,20.14,20.14,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90321182,,Reconstruct cranial bone,A,,31.77,17.69,NA,17.69,,5.90,55.36,55.36,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90421183,,Reconstruct cranial bone,A,,34.81,18.81,NA,18.81,,6.46,60.08,60.08,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90521184,,Reconstruct cranial bone,A,,37.65,19.84,NA,19.84,,7.01,64.50,64.50,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014