$859.62
Choose 21208 when the surgeon adds projection or support to facial bone; choose 21209 when the service reduces facial-bone prominence.
On this page
CMS RVU26D · Effective 2026-10-01
21208 Bone augmentation Medicare reimbursement rates in Hawaii
Surgical augmentation of facial bone contour is reported when a surgeon adds structural support or projection to deficient facial skeletal areas. Compare 21208 office and facility rates across CMS payment localities in Hawaii.
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 21208 in Hawaii?
Hawaii 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
$1808.68
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$687.23
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 21208: Facial Bone Augmentation Surgery
Surgical augmentation of facial bone contour is reported when a surgeon adds structural support or projection to deficient facial skeletal areas.
This operation increases projection or support in an underdeveloped or deficient facial bone area. A surgeon may use an implant or graft material to augment the facial skeleton; the operative record should identify the treated site and the method used. Oral and maxillofacial, plastic, and craniofacial surgeons may perform the procedure in an operating room or another appropriate surgical setting.
Report the code for the facial-bone augmentation itself, not for reduction or a distinct reconstructive service. Document the anatomic site, the deficiency being treated, and the augmentation performed. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one 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 requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21208
- 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 RVU11.13 · 22%
- Practice expense (office) RVU37.17 · 75%
- Malpractice RVU1.31 · 3%
893
Medicare services in 2024 · #3051 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.
21208 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$1,962.22
21210 describes bone grafting to nasal, maxillary, or malar areas. Use 21208 when the documented service is facial-bone augmentation rather than the graft service.
$1,172.32
21270 is associated specifically with cheekbone augmentation. Distinguish it from 21208 by the documented procedure and treated site.
No office rate
21206 describes reconstruction of the upper jaw. Use 21208 for facial-bone augmentation when the documented service is not upper-jaw reconstruction.
Compare 21208 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
$1808.68
Facility
$687.23
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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 21208 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,914
- Code
- 21208
- Physician work
- 11.13
- Practice expense
- 37.17
- Malpractice
- 1.31
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.13 | × 1.000 | 11.1300 |
| Practice expense | 37.17 | × 1.137 | 42.2623 |
| Malpractice | 1.31 | × 0.579 | 0.7585 |
| Total RVUs | 54.1508 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$1808.68
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.13 | 1 |
| Practice expense | 37.17 | 1.137 |
| Malpractice | 1.31 | 0.579 |
(11.13 × 1 + 37.17 × 1.137 + 1.31 × 0.579) × $33.4009 = $1808.68
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.13 | 1 |
| Practice expense | 7.64 | 1.137 |
| Malpractice | 1.31 | 0.579 |
(11.13 × 1 + 7.64 × 1.137 + 1.31 × 0.579) × $33.4009 = $687.23
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.
21208 billing questions
How is augmentation distinguished from facial-bone reduction?
Report augmentation when the surgeon adds projection or structural support to facial bone. Code 21209 describes reduction, which removes or decreases facial bone prominence.
When should cheekbone augmentation be considered separately?
Code 21270 is the nearby code specifically associated with cheekbone augmentation. Select the code that matches the documented operative site and service.
Does the 90-day global include related follow-up care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral augmentation?
No. CMS identifies bilateral adjustment as inappropriate for this code's descriptor or anatomy.
When is assistant-at-surgery payment allowed?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are 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 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.
1,91121198,,Reconstr lwr jaw segment,A,,15.32,9.88,NA,9.88,,2.01,27.21,27.21,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91221199,,Reconstr lwr jaw w/advance,A,,16.31,8.45,NA,8.45,,2.37,27.13,27.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91321206,,Reconstruct upper jaw bone,A,,15.20,9.19,NA,9.19,,1.76,26.15,26.15,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91421208,,Augmentation of facial bones,A,,11.13,37.17,,7.64,,1.31,49.61,20.08,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91521209,,Reduction of facial bones,A,,7.62,15.46,,8.02,,0.93,24.01,16.57,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91621210,,Face bone graft,A,,11.40,40.96,,8.01,,1.34,53.70,20.75,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91721215,,Lower jaw bone graft,A,,11.92,110.02,,8.24,,1.41,123.35,21.57,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,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