$3,688.23–$4,101.65
Choose 21125 for augmentation with prosthetic material; 21127 describes mandibular augmentation using bone graft.
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CMS RVU26D · Effective 2026-10-01
21125 Mandibular augmentation Medicare reimbursement rates in Illinois
Reports mandibular augmentation using prosthetic material to enlarge or restore jaw contour, rather than augmentation with bone graft or repositioning by osteotomy. Compare 21125 office and facility rates across CMS payment localities in Illinois.
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 21125 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$2426.64–$2688.74
4 of 4 localities have a supported rate.
Facility setting
$609.74–$661.42
4 of 4 localities have a supported rate.
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.
Where 21125 pays more and less in Illinois
4 payment localities
$2426.64 to $2688.74
Oral and maxillofacial surgery
About 21125: Mandibular augmentation with prosthetic implant
Reports mandibular augmentation using prosthetic material to enlarge or restore jaw contour, rather than augmentation with bone graft or repositioning by osteotomy.
Mandibular augmentation with a prosthetic implant enlarges or restores jaw contour by placing alloplastic material along a deficient segment of the mandible. It is distinct from bone-graft augmentation and from an osteotomy that repositions native jaw segments. Oral and maxillofacial surgeons and plastic surgeons typically perform the procedure in an operating room for reconstructive or contour-correction needs, using an implant selected for the documented mandibular deficiency.
Report 21125 when the operative service augments the mandible with prosthetic material. The note should identify the treated mandibular area, the indication, the implant and its placement, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21125
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.53 · 14%
- Practice expense (office) RVU65.97 · 85%
- Malpractice RVU1.21 · 2%
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.
21125 compared with similar codes
Office rates for Illinois, from the same CMS release.
$687.62–$759.00
21120 describes augmentation performed as a genioplasty. 21125 describes prosthetic augmentation of the mandible rather than chin-focused genioplasty.
No office rate
21123 includes a sliding osteotomy along with augmentation. 21125 describes mandibular augmentation with prosthetic material without that osteotomy service.
Compare 21125 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$2661.40
Facility
$661.42
East St. Louis →
Office / nonfacility
$2460.29
Facility
$629.46
Rest Of Illinois →
Office / nonfacility
$2426.64
Facility
$609.74
Suburban Chicago →
Office / nonfacility
$2688.74
Facility
$644.98
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21125 billing questions
How does 21125 differ from 21127?
21125 describes mandibular augmentation with prosthetic material. 21127 is the related augmentation code for bone grafting.
When is 21120 a better fit?
Use 21120 for augmentation performed as a genioplasty, such as chin augmentation. Use 21125 when the documented service is mandibular augmentation with prosthetic material.
Can 21125 be reported with modifier 50?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global includes the day-before preoperative visit and related postoperative care through the 90-day period.
Can an assistant surgeon be paid for 21125?
CMS indicates that assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted.
What documentation supports 21125?
Document the mandibular area treated, the indication for augmentation, the prosthetic material and its placement, and the operative work performed.
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.
1,87821121,,Geniop sldg osteot 1,A,,7.61,10.98,,6.10,,0.87,19.46,14.58,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87921122,,Geniop sldg osteot 2/>,A,,8.49,10.90,NA,10.90,,1.57,20.96,20.96,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88021123,,Geniop sldg augmentation,A,,11.06,10.62,NA,10.62,,1.61,23.29,23.29,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88121125,,Augmentation mndblr prostc,A,,10.53,65.97,,6.39,,1.21,77.71,18.13,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88221127,,Augmentation mndblr b1 grf,A,,12.13,105.28,,7.31,,1.39,118.80,20.83,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88321137,,Rdctj forehead cntrg only,A,,9.98,8.68,NA,8.68,,1.85,20.51,20.51,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88421138,,Rdctj forehead cntrg&prostc,A,,12.55,9.86,NA,9.86,,2.34,24.75,24.75,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00