No office rate
21048 is for a maxillary benign cyst or lesion excision requiring an intraoral osteotomy. Choose 21049 when the operative extent requires an extraoral approach, partial maxillary resection, and repair.
On this page
CMS RVU26D · Effective 2026-10-01
21049 Maxillary cyst excision Medicare reimbursement rates in Kentucky
Reports removal of a maxillary cyst or benign lesion when the extent requires an extraoral approach, partial maxillary resection, and repair. Compare 21049 office and facility rates across CMS payment localities in Kentucky.
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 21049 in Kentucky?
Kentucky 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
$979.71
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 21049: Maxillary cyst excision with repair
Reports removal of a maxillary cyst or benign lesion when the extent requires an extraoral approach, partial maxillary resection, and repair.
This service addresses a benign cyst or lesion of the upper jaw that requires an extraoral surgical approach and removal of part of the maxilla, with repair of the resulting defect. An oral and maxillofacial surgeon or another surgeon experienced in maxillary surgery may perform it in an operating room. The operative report should identify the maxillary lesion, the extraoral approach, the bone removed, and the repair performed.
Select this code for the documented extent of maxillary excision and repair, rather than a less extensive removal or a procedure on the mandible. It 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. Bilateral adjustment is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21049
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.84 · 62%
- Practice expense (office) RVU9.27 · 30%
- Malpractice RVU2.46 · 8%
197
Medicare services in 2024 · #4338 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.
21049 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$441.40
21030 describes maxillary benign cyst or tumor removal by enucleation and curettage. It is not the choice for the more extensive maxillary resection and repair represented by 21049.
No office rate
21047 concerns an extensive benign cyst or tumor excision of the mandible. 21049 is for the corresponding upper-jaw site.
$1,225.73
21034 is for a malignant tumor of the maxilla or zygoma. 21049 is for a benign cyst or lesion requiring extensive maxillary removal and repair.
Compare 21049 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$979.71
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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 21049 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
1,856
- Code
- 21049
- Physician work
- 18.84
- Practice expense
- 9.27
- Malpractice
- 2.46
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.84 | × 1.000 | 18.8400 |
| Practice expense | 9.27 | × 0.889 | 8.2410 |
| Malpractice | 2.46 | × 0.915 | 2.2509 |
| Total RVUs | 29.3319 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$979.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.84 | 1 |
| Practice expense | 9.27 | 0.889 |
| Malpractice | 2.46 | 0.915 |
(18.84 × 1 + 9.27 × 0.889 + 2.46 × 0.915) × $33.4009 = $979.71
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.
21049 billing questions
How does this differ from 21048?
Use 21049 when the documented maxillary excision requires an extraoral approach, partial maxillary resection, and repair. 21048 describes a less extensive maxillary cyst or benign-lesion excision requiring an intraoral osteotomy.
Can the cyst removal and repair be reported separately?
The repair is part of the service described by this code. The operative documentation should show the lesion removal, extent of bone resection, and repair.
Should modifier 50 be appended for bilateral disease?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does the 90-day global period affect follow-up visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.
What happens when another procedure is 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.
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.
1,85321046,,Remove mandible cyst complex,A,,13.85,11.32,NA,11.32,,1.76,26.93,26.93,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85421047,,Excise lwr jaw cyst w/repair,A,,19.57,10.05,NA,10.05,,2.61,32.23,32.23,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85521048,,Remove maxilla cyst complex,A,,14.34,11.05,NA,11.05,,1.76,27.15,27.15,0,090,0.10,0.69,0.21,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85621049,,Excis uppr jaw cyst w/repair,A,,18.84,9.27,NA,9.27,,2.46,30.57,30.57,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85721050,,Removal of jaw joint,A,,11.47,10.70,NA,10.70,,1.66,23.83,23.83,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85821060,,Remove jaw joint cartilage,A,,10.79,9.13,NA,9.13,,1.56,21.48,21.48,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85921070,,Remove coronoid process,A,,8.40,6.54,NA,6.54,,1.23,16.17,16.17,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631