CPT code 21435: Craniofacial fracture repair2026 Medicare rate & RVUs in Nevada
Reports open operative repair of a complicated LeFort III craniofacial separation when internal and/or external fixation is used to stabilize the fracture.
CMS doesn’t publish an office rate for 21435 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 21435 covers
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.
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 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $1,241.62 |
How the 21435 rate is calculated
Each of 21435’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 · 21435
RVUs × geographic indexes × conversion factor
Work19.75
19.75 RVUs× 1.000 GPCI
Practice expense14.36
14.36 RVUs× 1.000 GPCI
Malpractice3.66
3.66 RVUs× 1.000 GPCI
Adjusted RVUs
37.7700
Conversion factor
$33.4009
Medicare rate
$1,261.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21435
21435 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21435
Craniofacial fracture 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) | 0 | Not permitted. |
| 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 · 21435
Craniofacial fracture 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
21435 without 51 · national facility
$1,261.55
Craniofacial fracture repair
21435-51 · Second procedure: 50%
$630.78
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%).
21435 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21431Fracture treatment
- 21431 is for closed treatment of a LeFort III-type separation. Choose 21435 for open repair with internal and/or external fixation.
- 21433Craniofacial repair
- 21433 identifies complicated open repair with multiple approaches. 21435 identifies complicated repair with internal and/or external fixation.
- 21436Craniofacial fracture repair
- 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.
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 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
Fee sheets
Put 21435 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →