No office rate
Both are two-piece LeFort I reconstructions; 21146 includes bone grafting, while 21142 is the corresponding code without graft.
On this page
CMS RVU26D · Effective 2026-10-01
21146 Midface reconstruction Medicare reimbursement rates in Kentucky
Reports LeFort I midface reconstruction when the maxilla is divided into two segments and bone grafting is part of the reconstruction. Compare 21146 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 21146 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
$1384.62
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.
Craniofacial surgery
About 21146: Two-piece LeFort I reconstruction with graft
Reports LeFort I midface reconstruction when the maxilla is divided into two segments and bone grafting is part of the reconstruction.
This procedure reconstructs the midface through a LeFort I approach, mobilizing and repositioning the maxilla as two segments and incorporating bone graft. Oral and maxillofacial surgeons and craniofacial or plastic surgeons typically perform it in an operating room for selected maxillary deformities requiring segmental reconstruction. The operative report should support the LeFort I level, two-piece configuration, and grafting performed.
Select this code when the reconstruction uses two maxillary segments with bone graft; the segment count and graft distinguish it from nearby LeFort I codes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. 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% reduction. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 21146
- 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 RVU24.25 · 56%
- Practice expense (office) RVU15.74 · 36%
- Malpractice RVU3.51 · 8%
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.
21146 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Both include bone grafting at the LeFort I level. Choose 21145 for a one-piece configuration and 21146 for two pieces.
No office rate
Both include bone grafting at the LeFort I level. 21147 is for three or more pieces; 21146 is for two.
No office rate
Both describe LeFort I reconstruction in three or more pieces. 21143 is without graft; 21146 is a two-piece reconstruction with graft.
Compare 21146 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
$1384.62
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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 21146 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
1,890
- Code
- 21146
- Physician work
- 24.25
- Practice expense
- 15.74
- Malpractice
- 3.51
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.25 | × 1.000 | 24.2500 |
| Practice expense | 15.74 | × 0.889 | 13.9929 |
| Malpractice | 3.51 | × 0.915 | 3.2117 |
| Total RVUs | 41.4545 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1384.62
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.25 | 1 |
| Practice expense | 15.74 | 0.889 |
| Malpractice | 3.51 | 0.915 |
(24.25 × 1 + 15.74 × 0.889 + 3.51 × 0.915) × $33.4009 = $1384.62
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.
21146 billing questions
How does this differ from 21142?
Both describe a two-piece LeFort I reconstruction. This code includes bone grafting; 21142 describes the two-piece configuration without grafting.
How does this differ from 21145?
Both include grafting, but 21145 is for a one-piece LeFort I reconstruction. Use this code when the maxilla is reconstructed in two segments.
When is 21147 a better fit?
Use 21147 when the grafted LeFort I reconstruction divides the maxilla into three or more pieces. The operative documentation should establish the segment count.
Is related postoperative care separately reported?
The 90-day global period includes related postoperative care and the day-before preoperative visit. The global period begins with the surgery.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery 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.
1,88721142,,Rcnstj midface lefort i 2pcs,A,,19.77,14.43,NA,14.43,,2.87,37.07,37.07,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88821143,,Rcnstj mdface lefort i 3/>pc,A,,20.52,14.63,NA,14.63,,2.98,38.13,38.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88921145,,Rcnstj mdfc lefort i 1 w/grf,A,,23.34,14.92,NA,14.92,,3.38,41.64,41.64,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89021146,,Rcnstj mdfc lefort i 2 w/grf,A,,24.25,15.74,NA,15.74,,3.51,43.50,43.50,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89121147,,Rcnstj mdfc lefort i 3/>grf,A,,25.81,16.11,NA,16.11,,3.75,45.67,45.67,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89221150,,Rcnstj mdfc lefrtii ant ntru,A,,25.31,13.37,NA,13.37,,3.69,42.37,42.37,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89321151,,Rcnstj mdfc lefrtii w/b1 grf,A,,28.29,14.10,NA,14.10,,4.13,46.52,46.52,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,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