Billing code 21045: Mandible tumor resectionMedicare rate & RVUs in Illinois
Report this service for extensive surgical removal of a malignant mandibular tumor when the operative work requires a broad resection of jaw bone.
CMS doesn’t publish an office rate for 21045 in Illinois.
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 21045 covers
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.
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 21045 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,184.41 |
| East St. Louis | Unavailable | $1,123.14 |
| Rest Of Illinois | Unavailable | $1,079.71 |
| Suburban Chicago | Unavailable | $1,145.27 |
How the 21045 rate is calculated
Each of 21045’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 · 21045
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.91Practice expense 11.15Malpractice 2.71
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21045
21045 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21045
Mandible tumor resection
| 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 · 21045
Mandible tumor resection
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
21045 without 51 · national facility
$1,061.15
Mandible tumor resection
21045-51 · Second procedure: 50%
$530.58
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%).
21045 compared with similar codes
Compare codes
21045 vs 21044 vs 21040 vs 21025 vs 21034: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21044Jaw tumor excision
- Both address malignant tumors of the mandible. Choose 21045 when the documented bone removal is extensive; 21044 represents the less extensive resection.
- 21040Mandibular lesion excision
- This code is for a benign mandibular tumor or cyst. A malignant mandibular tumor requiring extensive resection points to 21045.
- 21025Bone excision
- 21025 describes excision of mandibular bone, while 21045 is specific to extensive resection for a malignant mandibular tumor.
- 21034Tumor excision
- 21034 applies to malignant tumors of the maxilla or zygoma. Use 21045 for the corresponding extensive malignant tumor resection in the mandible.
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 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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