Billing code 21151: Midface reconstructionMedicare rate & RVUs in Illinois
Reconstructs the midface using a LeFort II osteotomy and bone graft, typically for significant midface deficiency requiring skeletal advancement or rebuilding.
CMS doesn’t publish an office rate for 21151 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 21151 covers
This operation reconstructs the central midface by repositioning the LeFort II segment and using bone graft to support the skeletal repair. Craniofacial and oral and maxillofacial surgeons may perform it for substantial midface hypoplasia, including deficiency associated with craniofacial syndromes. It is generally performed in an operating room, with the operative report identifying the osteotomy, graft use, and reconstructed anatomy.
Report 21151 when the documented reconstruction is a LeFort II procedure with bone graft; the surgical approach and grafting must support that selection rather than a different LeFort level or configuration. The code includes obtaining an autograft, so do not separately report the harvest as an independent service. The day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons and team surgery are 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 21151 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 | $1,741.42 |
| East St. Louis | Unavailable | $1,656.01 |
| Rest Of Illinois | Unavailable | $1,590.50 |
| Suburban Chicago | Unavailable | $1,679.63 |
How the 21151 rate is calculated
Each of 21151’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 · 21151
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 28.29Practice expense 14.10Malpractice 4.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21151
21151 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21151
Midface 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 21151
Midface 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 51 · payment effect
With and without the modifier
21151 without 51 · national facility
$1,553.81
Midface reconstruction
21151-51 · Second procedure: 50%
$776.91
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%).
21151 compared with similar codes
Compare codes
21151 vs 21150 vs 21145 vs 21154: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21150Midface reconstruction
- Both involve LeFort II reconstruction, but 21150 identifies an anterior-intrusion configuration; 21151 is the bone-graft configuration. Follow the operative details.
- 21145LeFort I reconstruction
- This is a one-piece LeFort I reconstruction with graft. Use 21151 when the documented osteotomy and reconstruction are LeFort II.
- 21154Midface reconstruction
- This describes LeFort III reconstruction without LeFort I involvement. The operative level and extent, not the general goal of midface advancement, determine the choice.
21151 billing questions
How do I distinguish 21151 from 21150?
21151 describes LeFort II reconstruction with bone graft. Code 21150 identifies the LeFort II anterior-intrusion configuration; select based on the documented operation, not simply whether both procedures involve the midface.
Can the autograft harvest be reported separately?
No. The code includes obtaining an autograft, so the harvest is part of the reported reconstruction.
Does the code include postoperative care?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral work?
No. The descriptor and anatomy make a bilateral adjustment with modifier 50 inappropriate.
How are other same-session procedures paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
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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