$1,049.38–$1,143.14
Both use an endosteal implant approach. The distinction is the documented extent: complete for 21249 and partial for 21248.
On this page
CMS RVU26D · Effective 2026-10-01
21249 Jaw reconstruction Medicare reimbursement rates in Massachusetts
Reports complete reconstruction of the mandible or maxilla using endosteal implants, when the operative service addresses the full jaw rather than a partial extent. Compare 21249 office and facility rates across CMS payment localities in Massachusetts.
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 21249 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$1436.58–$1560.01
2 of 2 localities have a supported rate.
Facility setting
$1021.56–$1089.42
2 of 2 localities have a supported rate.
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 21249: Complete endosteal jaw reconstruction
Reports complete reconstruction of the mandible or maxilla using endosteal implants, when the operative service addresses the full jaw rather than a partial extent.
This service reconstructs the mandible or maxilla with implants placed within the jawbone to support dental restoration. Oral and maxillofacial surgeons commonly perform it for patients who need complete jaw rehabilitation, such as extensive tooth loss or loss of jaw support. The operative report should identify the jaw treated, the endosteal implant approach, and the full extent of reconstruction. The complete level is distinguished from the partial service by the extent treated, not simply by the number of implants.
Report the code when the documented procedure is complete endosteal implant reconstruction, rather than partial reconstruction or a different implant method. CMS assigns a 90-day major-surgery 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. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21249
- 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 RVU18.30 · 44%
- Practice expense (office) RVU21.44 · 51%
- Malpractice RVU2.31 · 5%
87
Medicare services in 2024 · #4979 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.
21249 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Both represent complete jaw reconstruction, but 21246 uses a subperiosteal implant approach; 21249 uses endosteal implants.
$4,311.57–$4,844.05
21215 addresses bone grafting of the mandible. This code describes complete endosteal implant-based jaw reconstruction, not bone grafting alone.
Compare 21249 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$1560.01
Facility
$1089.42
Rest Of Massachusetts →
Office / nonfacility
$1436.58
Facility
$1021.56
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21249 billing questions
How does this code differ from 21248?
Both describe endosteal implant reconstruction of the mandible or maxilla. Use 21249 when the documented reconstruction is complete; 21248 represents the partial extent.
How is this different from subperiosteal implant reconstruction?
This code is for an endosteal approach, with implants placed within the jawbone. Codes 21245 and 21246 describe subperiosteal implant reconstruction, with partial and complete extents, respectively.
Does the 90-day global include postoperative visits?
Related postoperative care through the 90-day global period is included, as is the day-before preoperative visit.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
When is an assistant-at-surgery claim payable?
CMS allows assistant-at-surgery payment only when medical necessity is documented.
Can this code be reported with another procedure performed in the same session?
When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard 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.
1,92521246,,Reconstruction of jaw,A,,12.60,8.56,NA,8.56,,1.83,22.99,22.99,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92621247,,Reconstruct lower jaw bone,A,,23.76,15.28,NA,15.28,,3.45,42.49,42.49,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92721248,,Reconstruction of jaw,A,,12.42,16.71,,7.79,,1.51,30.64,21.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92821249,,Reconstruction of jaw,A,,18.30,21.44,,9.64,,2.31,42.05,30.25,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92921255,,Reconstruct lower jaw bone,A,,18.00,15.95,NA,15.95,,2.61,36.56,36.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93021256,,Reconstruction of orbit,A,,17.22,12.97,NA,12.97,,3.19,33.38,33.38,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93121260,,Revise eye sockets,A,,17.45,16.80,NA,16.80,,3.23,37.48,37.48,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00