Billing code 21433: Craniofacial repairMedicare rate & RVUs in Nevada
Reports complicated open repair of a LeFort III-type craniofacial separation when the surgeon uses multiple operative approaches to treat the injury.
CMS doesn’t publish an office rate for 21433 in Nevada.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 21433 covers
This code describes open repair of a severe craniofacial separation of the LeFort III type using multiple operative approaches. The surgeon exposes and realigns the separated facial skeleton and stabilizes the repair as clinically required. Oral and maxillofacial surgeons, plastic surgeons, and other surgeons with craniofacial expertise may perform this operation, generally in a hospital operating room after major facial trauma.
Choose this code when the documented injury and operation support complicated open treatment through multiple approaches; the operative report should establish the fracture pattern, complexity, approaches used, and repair performed. It has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
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.
21433 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $1,500.38 |
How the 21433 rate is calculated
Each of 21433’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21433
RVUs × geographic indexes × conversion factor
Work25.63
25.63 RVUs× 1.000 GPCI
Practice expense15.31
15.31 RVUs× 1.000 GPCI
Malpractice4.76
4.76 RVUs× 1.000 GPCI
Adjusted RVUs
45.7000
Conversion factor
$33.4009
Medicare rate
$1,526.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21433
21433 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21433
Craniofacial repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21433
Craniofacial repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21433 without 51 · national facility
$1,526.42
Craniofacial repair
21433-51 · Second procedure: 50%
$763.21
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21433 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21431Fracture treatment
- 21431 is closed treatment of a craniofacial separation. Choose 21433 for complicated open repair through multiple approaches.
- 21432Craniofacial repair
- 21432 describes open treatment with wiring. Code 21433 is for complicated multiple-approach repair, not simply the use of wiring.
- 21435Craniofacial fracture repair
- 21435 identifies complicated open treatment with internal and/or external fixation. Code 21433 distinguishes complicated treatment using multiple approaches.
- 21436Craniofacial fracture repair
- 21436 is the multiple-approach sibling that specifies internal fixation. Use 21433 when that specific internal-fixation distinction is not the basis for code selection.
21433 billing questions
When should this code be selected instead of 21431?
Use 21433 for complicated open repair of a LeFort III-type separation involving multiple approaches. Code 21431 describes closed treatment of the separation.
How does this differ from 21432?
Code 21432 describes open treatment with wiring of the bones. For 21433, the documented procedure must support complicated treatment using multiple approaches.
What documentation supports reporting 21433?
The operative report should identify the LeFort III-type craniofacial separation, explain its complexity, and describe the multiple approaches and repair performed.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative care?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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