Billing code 21155: Midface reconstructionMedicare rate & RVUs in Illinois
Reports LeFort III-level midface reconstruction using an interpositional bone graft to support repositioned facial segments, commonly for significant midface hypoplasia.
CMS doesn’t publish an office rate for 21155 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 21155 covers
This procedure reconstructs the midface at the LeFort III level, mobilizing the central and lateral midfacial skeleton and placing an interpositional bone graft between repositioned segments. Craniofacial, plastic, or oral and maxillofacial surgeons may perform it for substantial midface deficiency, including deficiency associated with craniosynostosis or other craniofacial conditions. It is a major reconstructive operation generally performed in a hospital setting.
Select this code when the documented LeFort III reconstruction includes an interpositional bone graft; the operative report should identify the reconstruction level, repositioning performed, and graft placement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this descriptor and anatomy. 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 21155 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 | $2,078.83 |
| East St. Louis | Unavailable | $1,978.13 |
| Rest Of Illinois | Unavailable | $1,898.90 |
| Suburban Chicago | Unavailable | $2,003.13 |
How the 21155 rate is calculated
Each of 21155’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 · 21155
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 34.34Practice expense 16.08Malpractice 5.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21155
21155 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21155
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 · 21155
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
21155 without 51 · national facility
$1,851.41
Midface reconstruction
21155-51 · Second procedure: 50%
$925.71
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%).
21155 compared with similar codes
Compare codes
21155 vs 21154 vs 21159 vs 21160 vs 21151: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21154Midface reconstruction
- Use 21154 for LeFort III midface reconstruction without an interpositional bone graft; 21155 includes the interpositional graft.
- 21159Midface reconstruction
- 21159 is the LeFort III advancement option without an interpositional graft. This code is for LeFort III reconstruction with an interpositional graft when the advancement-specific code does not describe the procedure.
- 21160Midface reconstruction
- 21160 describes LeFort III advancement with an interpositional graft. Use 21155 for the corresponding grafted LeFort III reconstruction when the procedure is not the advancement-specific service.
- 21151Midface reconstruction
- 21151 is a LeFort II reconstruction with a bone graft. The operative level is LeFort III for 21155.
21155 billing questions
How does this differ from 21154?
Both describe LeFort III midface reconstruction. Choose 21155 when an interpositional bone graft is used; 21154 describes the reconstruction without that graft.
When would 21159 or 21160 be considered instead?
Those codes describe LeFort III reconstruction specifically identified as advancement. Their graft distinction is without interpositional graft for 21159 and with interpositional graft for 21160.
Can modifier 50 be reported?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
What documentation supports reporting 21155?
The operative report should establish LeFort III-level reconstruction and describe placement of an interpositional bone graft. It should distinguish the procedure from a LeFort III advancement when that is the operation performed.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. The 90-day global period includes the day-before preoperative visit and related postoperative care.
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
Fee sheets
Put 21155 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →