No office rate
Both describe open repair in the palatal or maxillary fracture family. Select 21423 when the repair is complicated and uses multiple approaches; use 21422 for open repair without that distinction.
On this page
CMS RVU26D · Effective 2026-10-01
21423 Fracture repair Medicare reimbursement rates in Michigan
Reports open surgical repair of a palatal or maxillary fracture when its complexity requires multiple surgical approaches for exposure, reduction, or stabilization. Compare 21423 office and facility rates across CMS payment localities in Michigan.
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 21423 in Michigan?
Michigan 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
$703.88–$756.10
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.
Facial fracture surgery
About 21423: Complicated open palatal or maxillary fracture repair
Reports open surgical repair of a palatal or maxillary fracture when its complexity requires multiple surgical approaches for exposure, reduction, or stabilization.
This service is open repair of a fracture involving the palate or maxilla when the complexity calls for multiple surgical approaches. The surgeon exposes the fracture, restores alignment, and stabilizes the involved bones. Oral and maxillofacial surgeons and other facial trauma surgeons commonly perform this work in an operating room, often for displaced injuries that cannot be managed with closed treatment alone.
Choose this code when the operative report supports complicated open repair using multiple approaches; a routine open repair is distinguished from this level. Document the fracture site, displacement and complexity, approaches used, and reduction and fixation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not. Modifier 50 is inappropriate for this code.
CMS billing rules for 21423
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.58 · 49%
- Practice expense (office) RVU9.07 · 42%
- Malpractice RVU1.96 · 9%
58
Medicare services in 2024 · #5263 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.
21423 compared with similar codes
Office rates for Michigan, from the same CMS release.
$624.40–$659.66
21421 describes closed treatment with wiring. This code describes complicated open treatment through multiple approaches.
$710.37–$750.58
21445 is for open treatment of a fracture confined to the mandibular or maxillary alveolar ridge. This code concerns complicated open repair of a palatal or maxillary fracture.
No office rate
21432 addresses open treatment of craniofacial separation with wiring. Choose this code for a complicated palatal or maxillary fracture repaired through multiple approaches instead.
Compare 21423 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
Detroit →
Office / nonfacility
Unavailable
Facility
$756.10
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$703.88
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21423 billing questions
How does this differ from 21422?
Use 21423 when the open repair is complicated and requires multiple approaches. Code 21422 describes open treatment without that added complexity.
When is 21421 more appropriate?
Code 21421 is for closed treatment of a palatal or maxillary fracture with wiring. This code is for complicated open repair using multiple approaches.
What operative documentation supports 21423?
Document the palatal or maxillary fracture, its complexity, the approaches used, and the reduction and stabilization performed. The record should make clear why multiple approaches were needed.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can assistant surgeons or co-surgeons be reported?
CMS permits assistant-at-surgery payment and co-surgeons for this code. Team surgery is not permitted.
Should modifier 50 be appended for bilateral treatment?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
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.
1,97321408,,Opn tx orbit fx w/bone grft,A,,12.46,9.60,NA,9.60,,2.32,24.38,24.38,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97421421,,Cltx palatal/max fx wire fix,A,,5.87,13.23,,8.85,,0.66,19.76,15.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97521422,,Optx palatal/max fracture,A,,8.51,7.92,NA,7.92,,1.24,17.67,17.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97621423,,Optx palatal/max fx comp,A,,10.58,9.07,NA,9.07,,1.96,21.61,21.61,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97721431,,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