No office rate
21431 is for closed treatment of a LeFort III-type separation. Choose 21435 for open repair with internal and/or external fixation.
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CMS RVU26D · Effective 2026-10-01
21435 Craniofacial fracture repair Medicare reimbursement rates in Massachusetts
Reports open operative repair of a complicated LeFort III craniofacial separation when internal and/or external fixation is used to stabilize the fracture. Compare 21435 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 21435 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
No supported rate
Facility setting
$1272.71–$1368.20
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.
Craniofacial surgery
About 21435: Complicated LeFort III fracture fixation
Reports open operative repair of a complicated LeFort III craniofacial separation when internal and/or external fixation is used to stabilize the fracture.
This service treats a severe LeFort III pattern, in which the midface is separated from the cranial framework. The surgeon exposes and repositions the fracture and stabilizes it with internal fixation, external fixation, or both. Oral and maxillofacial surgeons, plastic surgeons, otolaryngologists, and other surgeons with craniofacial trauma expertise may perform the repair, commonly in a hospital operating room after major facial trauma.
Select this code when the documented injury and operative work support the complicated open-treatment level and internal and/or external fixation. The operative report should identify the craniofacial separation, the repair performed, and the fixation used; use the related code distinctions for wiring or splinting and for multiple approaches. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21435
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU19.75 · 52%
- Practice expense (office) RVU14.36 · 38%
- Malpractice RVU3.66 · 10%
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.
21435 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
21433 identifies complicated open repair with multiple approaches. 21435 identifies complicated repair with internal and/or external fixation.
No office rate
21436 includes the multiple-approach distinction as well as internal and/or external fixation; 21435 is the fixation-level choice without that multiple-approach distinction.
Compare 21435 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
Unavailable
Facility
$1368.20
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1272.71
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21435 billing questions
How does 21435 differ from 21433?
21435 identifies complicated open repair using internal and/or external fixation. 21433 distinguishes complicated repair involving multiple approaches.
When would 21436 be selected instead?
Use 21436 when the documented complicated repair involves both multiple approaches and internal and/or external fixation.
How is 21435 different from 21431?
21431 describes closed treatment of a LeFort III-type separation. 21435 is for open operative repair with fixation.
Can an assistant surgeon be reported?
CMS indicates that assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
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.
1,97721431,,Cltx craniofacial separation,A,,7.70,10.79,NA,10.79,,0.88,19.37,19.37,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97821432,,Optx cranfcl sep w/wiring,A,,8.60,9.93,NA,9.93,,1.59,20.12,20.12,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97921433,,Optx cranfcl sep comp mlt,A,,25.63,15.31,NA,15.31,,4.76,45.70,45.70,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98021435,,Optx crnfc sep comp int&/xtr,A,,19.75,14.36,NA,14.36,,3.66,37.77,37.77,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98121436,,Optx crnfcl sep comp mlt int,A,,29.54,19.00,NA,19.00,,5.49,54.03,54.03,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98221440,,Cltx mndblr/max alv ridge fx,A,,3.35,19.95,,14.18,,0.48,23.78,18.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98321445,,Optx mndblr/max alv ridge fx,A,,6.10,15.76,,10.18,,0.69,22.55,16.97,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00