$1,863.81–$2,079.10
21461 describes open treatment of a mandibular fracture without interdental fixation and without the complicated designation. Choose 21470 when the operative documentation supports a complicated fracture.
On this page
CMS RVU26D · Effective 2026-10-01
21470 Mandibular fracture repair Medicare reimbursement rates in Massachusetts
Reports open surgical repair of a complicated mandibular fracture when operative reduction and stabilization are required for the injury. Compare 21470 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 21470 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
$1051.50–$1127.71
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 21470: Complicated mandibular fracture repair
Reports open surgical repair of a complicated mandibular fracture when operative reduction and stabilization are required for the injury.
This service covers open surgical management of a complicated fracture of the mandible, involving access to the fracture, realignment, and stabilization. It is typically performed by an oral and maxillofacial surgeon or another surgeon experienced in facial trauma in an operating room, often after significant facial injury. The repair may involve one or more fracture sites and may include fixation appropriate to the documented pattern and operative plan.
Report the code when the operative record supports a complicated mandibular fracture treated through an open approach; document the fracture pattern and sites, surgical exposure, reduction, and stabilization. The 90-day global period includes 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 others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21470
- 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 RVU17.10 · 55%
- Practice expense (office) RVU11.46 · 37%
- Malpractice RVU2.56 · 8%
252
Medicare services in 2024 · #4133 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.
21470 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$2,115.60–$2,358.35
21462 is for open mandibular fracture treatment with interdental fixation, without the complicated designation. The complicated fracture characterization distinguishes 21470.
No office rate
21454 describes open treatment using external fixation. Select 21470 for the complicated fracture service when external fixation is not the defining treatment distinction.
No office rate
21465 is specific to open treatment of a mandibular condylar fracture. Use 21470 for a complicated mandibular fracture outside that condylar-specific service.
Compare 21470 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
$1127.71
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1051.50
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21470 billing questions
How does this differ from 21461 or 21462?
Use 21470 when the mandibular fracture is documented and treated as complicated. Codes 21461 and 21462 describe open treatment of mandibular fractures without the complicated designation and distinguish whether interdental fixation is used.
Is routine postoperative care separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Should modifier 50 be appended for fractures on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting the complicated-fracture code?
Document the fracture sites and pattern, why the injury is considered complicated, the open surgical approach, and the reduction and stabilization performed.
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.
1,98921461,,Optx mndblr fx wo ntrdntl,A,,9.08,43.24,,18.66,,1.31,53.63,29.05,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99021462,,Optx mndblr fx w/ntrdntl,A,,10.73,48.58,,20.79,,1.61,60.92,33.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99121465,,Optx mndblr cndylr fx,A,,12.79,7.42,NA,7.42,,1.46,21.67,21.67,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99221470,,Optx complicated mndblr fx,A,,17.10,11.46,NA,11.46,,2.56,31.12,31.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99321480,,Cltx tmprmand dislc 1st/sbsq,A,,0.59,4.43,,0.19,,0.13,5.15,0.91,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99421485,,Cltx tmprmand dislc comp,A,,4.65,24.67,,17.77,,0.67,29.99,23.09,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99521490,,Optx tmprmand dislocation,A,,12.63,7.29,NA,7.29,,1.44,21.36,21.36,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00