Billing code 21445: Alveolar fractureMedicare rate & RVUs in Illinois
Report open surgical reduction and stabilization of a fracture involving the tooth-bearing alveolar ridge of the mandible or maxilla.
Medicare pays $720.37–$787.09 for 21445 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
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 21445 covers
This service treats a fracture of the tooth-bearing alveolar ridge in the mandible or maxilla through an open surgical approach. The surgeon exposes the fracture, restores the position of the bone and associated dental segment, and stabilizes it; interdental fixation may be used. Oral and maxillofacial surgeons commonly perform the procedure, generally in an operating-room setting. The code concerns the alveolar ridge, not a broader mandibular fracture or a fracture elsewhere in the facial skeleton.
Select 21445 when the operative report supports open exposure and treatment of the alveolar ridge fracture. Document the affected jaw and fracture site, the open approach, reduction and stabilization performed, and any fixation used. Interdental fixation is included when used. The code has a 90-day global period, including 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. Assistant-at-surgery payment may be made; 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 21445 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.
4 payment localities
$720.37 to $787.09
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $787.09 | $599.78 |
| East St. Louis | $734.45 | $562.98 |
| Rest Of Illinois | $720.37 | $550.21 |
| Suburban Chicago | $786.62 | $595.21 |
How the 21445 rate is calculated
Each of 21445’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 · 21445
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.10Practice expense 15.76Malpractice 0.69
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21445
21445 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21445
Alveolar fracture
| 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 · 21445
Alveolar fracture
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
21445 without 51 · national office
$753.19
Alveolar fracture
21445-51 · Second procedure: 50%
$376.60
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%).
21445 compared with similar codes
Compare codes
21445 vs 21440 vs 21461 vs 21462: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21440Fracture treatment
- 21440 describes closed treatment of the mandibular or maxillary alveolar ridge fracture. Choose 21445 when the surgeon uses an open approach.
- 21461Mandibular fracture repair
- 21461 applies to open treatment of a mandibular fracture without interdental fixation. 21445 is specific to an alveolar ridge fracture.
- 21462Mandibular fracture repair
- 21462 applies to open treatment of a mandibular fracture with interdental fixation. Use 21445 when the fracture is of the alveolar ridge.
21445 billing questions
How does 21445 differ from 21440?
21445 is for open surgical treatment of the alveolar ridge fracture. Use 21440 when the fracture is treated closed.
Is interdental fixation separately reported with 21445?
Interdental fixation used to stabilize the alveolar ridge fracture is included in 21445. Document the fixation method in the operative report.
When should a mandibular fracture code be considered instead?
Use a mandibular fracture code when the treated fracture involves a broader part of the mandible rather than the alveolar ridge. The operative documentation should identify the fracture site and treatment approach.
Can modifier 50 be reported for fractures on both sides?
No. The CMS bilateral adjustment does not apply to 21445, and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of 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
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