Billing code 21172: Forehead reconstructionMedicare rate & RVUs in Ohio
Reconstructs the supraorbital rim and lower forehead, commonly to correct a craniofacial deformity requiring reshaping of the upper facial skeleton.
CMS doesn’t publish an office rate for 21172 in Ohio.
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 21172 covers
This operation reshapes the bony framework of the lower forehead and supraorbital rim. It is typically performed by a craniofacial, plastic, or oral and maxillofacial surgeon in an operating room, often for a congenital craniofacial deformity such as craniosynostosis. The surgeon’s operative report should identify the reconstructed anatomy and describe the bony work performed.
Report the code when the documented procedure matches reconstruction of the supraorbital rim and lower forehead, rather than a broader bifrontal reconstruction or a different forehead reconstruction. Medicare assigns a 90-day global period; the day-before preoperative visit and related postoperative care during that period are included. 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. Modifier 50 is inappropriate for this code. Assistant-at-surgery services may be paid; co-surgeon payment requires 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.
21172 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $2,024.28 |
How the 21172 rate is calculated
Each of 21172’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 · 21172
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 27.50Practice expense 23.42Malpractice 11.63
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21172
21172 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21172
Forehead reconstruction
| 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 · 21172
Forehead reconstruction
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
21172 without 51 · national facility
$2,089.23
Forehead reconstruction
21172-51 · Second procedure: 50%
$1,044.62
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%).
21172 compared with similar codes
Compare codes
21172 vs 21175 vs 21179 vs 21180: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21175Forehead reconstruction
- 21175 describes a bifrontal reconstruction of the supraorbital rims and lower forehead. Select based on the anatomy and extent documented in the operative report.
- 21179Forehead reconstruction
- 21179 is a forehead reconstruction code specifying grafts. This code is defined by reconstruction of the supraorbital rim and lower forehead.
- 21180Forehead reconstruction
- 21180 specifies autograft use in forehead reconstruction. Choose it only when the documented procedure matches that graft-based service rather than this code’s anatomic description.
21172 billing questions
How is this distinguished from 21175?
This code describes reconstruction of the supraorbital rim and lower forehead. Code 21175 identifies a bifrontal reconstruction involving the supraorbital rims and lower forehead; use the code matching the operative work documented.
Should modifier 50 be reported for both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What documentation supports this code?
The operative report should identify the supraorbital rim and lower forehead as the reconstructed anatomy and describe the bony reconstruction 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 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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