No office rate
Both address malignant tumors of the mandible. Choose 21045 when the documented bone removal is extensive; 21044 represents the less extensive resection.
On this page
CMS RVU26D · Effective 2026-10-01
21045 Mandible tumor resection Medicare reimbursement rates in Idaho
Report this service for extensive surgical removal of a malignant mandibular tumor when the operative work requires a broad resection of jaw bone. Compare 21045 office and facility rates across CMS payment localities in Idaho.
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 21045 in Idaho?
Idaho 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
$983.65
1 of 1 localities have a supported rate.
Payment area: Idaho
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.
Oral and maxillofacial surgery
About 21045: Extensive malignant mandible tumor resection
Report this service for extensive surgical removal of a malignant mandibular tumor when the operative work requires a broad resection of jaw bone.
An oral and maxillofacial surgeon or head and neck surgeon performs this operation to remove a malignant tumor of the mandible when the required bone resection is extensive. It is typically performed in an operating room as part of cancer treatment. The operative report should identify the tumor site, the extent of mandibular bone removed, and the surgical approach; pathology findings support the malignant diagnosis.
Choose this code based on the documented extent of resection, not simply the tumor’s size or the fact that it is malignant. The less extensive malignant mandible resection code is a closer fit when the operative work does not reach this level. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When other 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. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21045
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.91 · 56%
- Practice expense (office) RVU11.15 · 35%
- Malpractice RVU2.71 · 9%
458
Medicare services in 2024 · #3637 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.
21045 compared with similar codes
Office rates for Idaho, from the same CMS release.
$445.56
This code is for a benign mandibular tumor or cyst. A malignant mandibular tumor requiring extensive resection points to 21045.
$779.40
21025 describes excision of mandibular bone, while 21045 is specific to extensive resection for a malignant mandibular tumor.
$1,209.16
21034 applies to malignant tumors of the maxilla or zygoma. Use 21045 for the corresponding extensive malignant tumor resection in the mandible.
Compare 21045 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
Idaho →
Office / nonfacility
Unavailable
Facility
$983.65
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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 21045 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,852
- Code
- 21045
- Physician work
- 17.91
- Practice expense
- 11.15
- Malpractice
- 2.71
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.91 | × 1.000 | 17.9100 |
| Practice expense | 11.15 | × 0.920 | 10.2580 |
| Malpractice | 2.71 | × 0.473 | 1.2818 |
| Total RVUs | 29.4498 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$983.65
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.91 | 1 |
| Practice expense | 11.15 | 0.92 |
| Malpractice | 2.71 | 0.473 |
(17.91 × 1 + 11.15 × 0.92 + 2.71 × 0.473) × $33.4009 = $983.65
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.
21045 billing questions
How is this different from 21044?
Use 21045 when the operative report supports the more extensive mandibular resection. Use 21044 for the less extensive malignant mandible tumor excision.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code based on its descriptor or anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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.
What documentation supports choosing this code?
Document the malignant diagnosis, mandibular site, and the extent of bone removed. The operative details should substantiate why the resection was extensive rather than the less extensive service.
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.
1,84921034,,Excise max/zygoma mal tumor,A,,16.95,19.64,,10.13,,2.50,39.09,29.58,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85021040,,Excise mandible lesion,A,,4.79,8.99,,4.73,,0.59,14.37,10.11,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85121044,,Removal of jaw bone lesion,A,,12.48,8.57,NA,8.57,,1.85,22.90,22.90,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85221045,,Extensive jaw surgery,A,,17.91,11.15,NA,11.15,,2.71,31.77,31.77,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85321046,,Remove mandible cyst complex,A,,13.85,11.32,NA,11.32,,1.76,26.93,26.93,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85421047,,Excise lwr jaw cyst w/repair,A,,19.57,10.05,NA,10.05,,2.61,32.23,32.23,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85521048,,Remove maxilla cyst complex,A,,14.34,11.05,NA,11.05,,1.76,27.15,27.15,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772