No office rate
Use 21196 when fixation is part of the documented reconstruction; 21195 describes the corresponding reconstruction without fixation.
On this page
CMS RVU26D · Effective 2026-10-01
21196 Mandibular reconstruction Medicare reimbursement rates in Indiana
Reports reconstruction of the mandibular rami, body, or angle when fixation is used to stabilize the reconstructed jaw. Compare 21196 office and facility rates across CMS payment localities in Indiana.
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 21196 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1208.04
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
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.
Oral and maxillofacial surgery
About 21196: Mandibular reconstruction with fixation
Reports reconstruction of the mandibular rami, body, or angle when fixation is used to stabilize the reconstructed jaw.
Code 21196 represents operative reconstruction of the mandibular rami, body, or angle with fixation to stabilize the reconstructed jaw. Oral and maxillofacial, plastic, or craniofacial surgeons may perform the procedure in a hospital or ambulatory surgery setting to address mandibular defects or deformity after trauma, tumor removal, or a congenital condition. The operative report should identify the reconstructed area, the clinical reason for reconstruction, the technique, and the fixation used; document grafting when relevant to choosing among mandibular reconstruction codes.
CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 21196
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU20.31 · 52%
- Practice expense (office) RVU15.56 · 40%
- Malpractice RVU2.95 · 8%
75
Medicare services in 2024 · #5102 by national volume
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.
21196 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
21193 is the mandibular reconstruction variant specified without bone graft. Distinguish it from 21196 using the documented procedure and applicable descriptor.
No office rate
21194 is the mandibular reconstruction variant specified with bone graft. Do not infer graft use solely from fixation documented for 21196.
Compare 21196 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.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$1208.04
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21196 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
1,910
- Code
- 21196
- Physician work
- 20.31
- Practice expense
- 15.56
- Malpractice
- 2.95
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.31 | × 1.000 | 20.3100 |
| Practice expense | 15.56 | × 0.927 | 14.4241 |
| Malpractice | 2.95 | × 0.486 | 1.4337 |
| Total RVUs | 36.1678 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1208.04
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.31 | 1 |
| Practice expense | 15.56 | 0.927 |
| Malpractice | 2.95 | 0.486 |
(20.31 × 1 + 15.56 × 0.927 + 2.95 × 0.486) × $33.4009 = $1208.04
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21196 billing questions
How does 21196 differ from 21195?
Both describe reconstruction of the mandibular rami, body, or angle. Code 21196 is the fixation variant; 21195 describes reconstruction without fixation.
Does fixation alone distinguish 21196 from 21193 or 21194?
Codes 21193 and 21194 distinguish reconstruction without or with a bone graft, respectively. Choose based on the documented procedure and applicable descriptor, rather than assuming fixation establishes graft use.
Should modifier 50 be added for bilateral reconstruction?
CMS prices 21196 as bilateral, and modifier 50 does not increase payment.
What documentation supports reporting 21196?
Document the mandibular area reconstructed, the indication, the reconstructive technique, and the fixation used. Record grafting when performed and relevant to code selection.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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.
1,90721193,,Reconst lwr jaw w/o graft,A,,18.43,12.08,NA,12.08,,2.68,33.19,33.19,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90821194,,Reconst lwr jaw w/graft,A,,21.27,13.97,NA,13.97,,3.07,38.31,38.31,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90921195,,Reconst lwr jaw w/o fixation,A,,18.68,15.06,NA,15.06,,2.71,36.45,36.45,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91021196,,Reconst lwr jaw w/fixation,A,,20.31,15.56,NA,15.56,,2.95,38.82,38.82,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91121198,,Reconstr lwr jaw segment,A,,15.32,9.88,NA,9.88,,2.01,27.21,27.21,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91221199,,Reconstr lwr jaw w/advance,A,,16.31,8.45,NA,8.45,,2.37,27.13,27.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91321206,,Reconstruct upper jaw bone,A,,15.20,9.19,NA,9.19,,1.76,26.15,26.15,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915