No office rate
Both address a Le Fort II-pattern nasomaxillary fracture. Choose 21345 for the specified closed stabilization and 21346 when treatment uses an open approach.
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CMS RVU26D · Effective 2026-10-01
21345 Midface fracture Medicare reimbursement rates in Iowa
Reports closed treatment of a Le Fort II-pattern nasomaxillary fracture when stabilization uses dental wiring or a denture or splint. Compare 21345 office and facility rates across CMS payment localities in Iowa.
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 21345 in Iowa?
Iowa 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
$734.09
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$522.61
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Facial fracture treatment
About 21345: Closed Le Fort II fracture treatment
Reports closed treatment of a Le Fort II-pattern nasomaxillary fracture when stabilization uses dental wiring or a denture or splint.
This code describes closed management of a nasomaxillary complex fracture with a Le Fort II pattern. The fracture is treated without open surgical exposure, and stabilization uses interdental wiring or fixation of a denture or splint. Oral and maxillofacial surgeons, otolaryngologists, and facial plastic surgeons may perform the service, commonly in a hospital or operating-room setting. It is not the code for an isolated nasal bone fracture or a septal fracture.
Select the code when the documented fracture pattern and closed treatment method match this service. The operative report should identify the injury, explain the closed approach, and record the stabilization performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21345
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.83 · 37%
- Practice expense (office) RVU13.81 · 58%
- Malpractice RVU1.29 · 5%
11
Medicare services in 2024 · #6159 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.
21345 compared with similar codes
Office rates for Iowa, from the same CMS release.
$146.29
21315 describes closed treatment of a nasal bone fracture without manipulation. It is for an isolated nasal fracture, not the Le Fort II-pattern nasomaxillary injury reported with 21345.
$202.43
21320 is for a nasal bone fracture treated with manipulation and stabilization. It does not represent closed treatment of a Le Fort II-pattern nasomaxillary fracture.
Compare 21345 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
Iowa →
Office / nonfacility
$734.09
Facility
$522.61
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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 21345 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
1,955
- Code
- 21345
- Physician work
- 8.83
- Practice expense
- 13.81
- Malpractice
- 1.29
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.83 | × 1.000 | 8.8300 |
| Practice expense | 13.81 | × 0.915 | 12.6362 |
| Malpractice | 1.29 | × 0.397 | 0.5121 |
| Total RVUs | 21.9783 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$734.09
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.83 | 1 |
| Practice expense | 13.81 | 0.915 |
| Malpractice | 1.29 | 0.397 |
(8.83 × 1 + 13.81 × 0.915 + 1.29 × 0.397) × $33.4009 = $734.09
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.83 | 1 |
| Practice expense | 6.89 | 0.915 |
| Malpractice | 1.29 | 0.397 |
(8.83 × 1 + 6.89 × 0.915 + 1.29 × 0.397) × $33.4009 = $522.61
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.
21345 billing questions
How is this different from 21346?
This code is for closed treatment of a Le Fort II-pattern nasomaxillary fracture with the specified stabilization. Use 21346 when the fracture is treated through an open approach.
Can this be reported for an isolated nasal bone fracture?
No. This code describes treatment of a nasomaxillary complex fracture with a Le Fort II pattern. Codes 21315 or 21320 address closed treatment of nasal bone fractures, depending on the treatment performed.
What documentation supports reporting this code?
Document the Le Fort II-pattern fracture, that treatment was closed, and the stabilization method, such as interdental wiring or fixation of a denture or splint.
Should modifier 50 be appended for bilateral fractures?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How are multiple procedures and surgical assistance handled?
For procedures performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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.
1,95221340,,Perq tx nasoethmoid fx,A,,11.20,6.93,NA,6.93,,1.63,19.76,19.76,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95321343,,Open tx dprsd front sinus fx,A,,13.96,13.17,NA,13.17,,2.05,29.18,29.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95421344,,Open tx compl front sinus fx,A,,21.03,12.31,NA,12.31,,3.05,36.39,36.39,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95521345,,Closed tx nose/jaw fx,A,,8.83,13.81,,6.89,,1.29,23.93,17.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95621346,,Opn tx nasomax fx w/fixj,A,,11.16,14.57,NA,14.57,,1.63,27.36,27.36,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95721347,,Opn tx nasomax fx multple,A,,13.19,13.01,NA,13.01,,1.92,28.12,28.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95821348,,Opn tx nasomax fx w/graft,A,,17.08,8.81,NA,8.81,,2.49,28.38,28.38,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136