Billing code 21247: Lower jaw reconstructionMedicare rate & RVUs in Guam
Reports major reconstructive surgery to restore lower-jaw bone, such as after substantial mandibular bone loss from trauma or tumor treatment.
CMS doesn’t publish an office rate for 21247 in Guam.
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 21247 covers
This code represents a major operation to reconstruct the mandible when bone has been lost or the jaw requires structural restoration. Oral and maxillofacial surgeons, plastic surgeons, and other surgeons with relevant expertise may perform the procedure in a hospital or other surgical facility. Clinical situations can include reconstruction after removal of a mandibular tumor or repair of major traumatic bone loss. The operative report should make clear the defect being reconstructed and the technique used.
Select this code based on the documented reconstructive service, distinguishing it from a bone graft alone and from other mandibular reconstruction methods in the neighboring codes. The record should identify the cause and extent of the defect, the reconstruction performed, and any graft or reconstructive materials used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Bilateral reporting with modifier 50 is paid at 150%. 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.
21247 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,440.61 |
How the 21247 rate is calculated
Each of 21247’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 · 21247
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.76Practice expense 15.28Malpractice 3.45
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21247
21247 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21247
Lower 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) | 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 · 21247
Lower 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 50 · payment effect
With and without the modifier
21247 without 50 · national facility
$1,419.20
Lower jaw reconstruction
21247-50 · Bilateral: 150%
$2,128.80
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).
21247 compared with similar codes
Compare codes
21247 vs 21215 vs 21244 vs 21248 vs 21249: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21215Bone graft
- 21215 describes bone grafting to the mandible. Report 21247 when the documented service is the broader lower-jaw reconstruction, not graft placement alone.
- 21244Jaw reconstruction
- 21244 is a neighboring mandibular reconstruction code with distinct operative criteria. Choose between the codes from the specific reconstruction method documented in the operative report.
- 21248Jaw reconstruction
- 21248 is an endosteal-implant reconstruction code. It is not interchangeable with this code when the documented procedure is a different form of mandibular reconstruction.
- 21249Jaw reconstruction
- 21249 is another endosteal-implant reconstruction option. The operative technique and extent documented determine whether it or 21247 describes the service.
21247 billing questions
How is this different from a mandibular bone graft code?
This code represents reconstruction of the lower jaw, rather than bone grafting as a standalone service. Use the operative documentation to distinguish the complete reconstructive procedure from graft placement alone.
What documentation supports reporting this code?
Document the mandibular defect or bone loss, its cause, the reconstruction performed, and the technique and materials used. The operative report should support why the service is a reconstruction rather than an isolated graft.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The procedure is major surgery under the CMS global-period rule.
Can this code be reported bilaterally?
CMS identifies it as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support reconstruction on both sides.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only when supporting documentation is provided; 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
Fee sheets
Put 21247 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →