No office rate
21193 describes lower-jaw reconstruction without bone graft. Use 21198 when the operation is documented as segmental reconstruction, rather than selecting by graft status alone.
On this page
CMS RVU26D · Effective 2026-10-01
21198 Jaw reconstruction Medicare reimbursement rates in Nebraska
Reports surgical reconstruction of a segment of the lower jaw, such as when a mandibular defect requires segment-focused repair rather than jaw advancement. Compare 21198 office and facility rates across CMS payment localities in Nebraska.
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 21198 in Nebraska?
Nebraska 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
$841.67
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Oral and maxillofacial surgery
About 21198: Segmental mandibular reconstruction
Reports surgical reconstruction of a segment of the lower jaw, such as when a mandibular defect requires segment-focused repair rather than jaw advancement.
This operation reconstructs a segment of the mandible to restore jaw continuity or contour. Oral and maxillofacial surgeons and other reconstructive surgeons may perform it in a hospital operating room for a defect related to trauma, tumor removal, or another condition requiring segmental repair. The operative report should identify the mandibular segment reconstructed and describe the work performed; the code is not selected merely because the procedure involves the lower jaw.
Report the code when the documented operation is segmental mandibular reconstruction, distinguishing it from the separate lower-jaw reconstruction approaches represented by 21193–21196 and from advancement under 21199. The procedure has a 90-day global period, including 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 other procedures are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21198
- 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 RVU15.32 · 56%
- Practice expense (office) RVU9.88 · 36%
- Malpractice RVU2.01 · 7%
413
Medicare services in 2024 · #3711 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.
21198 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
21194 describes lower-jaw reconstruction with bone graft. The defining distinction for 21198 is segmental reconstruction; confirm the operative approach rather than relying only on whether a graft was used.
No office rate
21199 is for lower-jaw reconstruction with advancement. 21198 is the segmental reconstruction option, not the advancement approach.
Compare 21198 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$841.67
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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 21198 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
1,911
- Code
- 21198
- Physician work
- 15.32
- Practice expense
- 9.88
- Malpractice
- 2.01
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.32 | × 1.000 | 15.3200 |
| Practice expense | 9.88 | × 0.923 | 9.1192 |
| Malpractice | 2.01 | × 0.378 | 0.7598 |
| Total RVUs | 25.1990 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$841.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.32 | 1 |
| Practice expense | 9.88 | 0.923 |
| Malpractice | 2.01 | 0.378 |
(15.32 × 1 + 9.88 × 0.923 + 2.01 × 0.378) × $33.4009 = $841.67
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.
21198 billing questions
How is 21198 distinguished from 21193–21196?
Use the operative description to determine whether the surgeon performed segmental mandibular reconstruction or one of the distinct lower-jaw reconstruction approaches represented by 21193–21196. Do not choose based only on the fact that the mandible was operated on.
When is 21199 a better fit?
21199 describes lower-jaw reconstruction with advancement. Choose 21198 when the documented procedure is segmental reconstruction rather than reconstruction by advancement.
What documentation supports reporting 21198?
Document the mandibular segment reconstructed, the defect or clinical reason for reconstruction, and the operative steps that establish segmental reconstruction. The note should make the distinction from other lower-jaw reconstruction approaches clear.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical episode.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed during the same session.
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.
1,90821194,,Reconst lwr jaw w/graft,A,,21.27,13.97,NA,13.97,,3.07,38.31,38.31,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90921195,,Reconst lwr jaw w/o fixation,A,,18.68,15.06,NA,15.06,,2.71,36.45,36.45,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91021196,,Reconst lwr jaw w/fixation,A,,20.31,15.56,NA,15.56,,2.95,38.82,38.82,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91121198,,Reconstr lwr jaw segment,A,,15.32,9.88,NA,9.88,,2.01,27.21,27.21,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91221199,,Reconstr lwr jaw w/advance,A,,16.31,8.45,NA,8.45,,2.37,27.13,27.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91321206,,Reconstruct upper jaw bone,A,,15.20,9.19,NA,9.19,,1.76,26.15,26.15,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91421208,,Augmentation of facial bones,A,,11.13,37.17,,7.64,,1.31,49.61,20.08,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068