Billing code 21245: Jaw reconstructionMedicare rate & RVUs in Ohio
Reports reconstruction of part of the mandible or maxilla with a subperiosteal implant, typically when severe jawbone loss limits conventional implant support.
Medicare pays $1,217.40 for 21245 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 21245 covers
This procedure reconstructs part of the mandible or maxilla using a subperiosteal implant positioned beneath the periosteum and over the jawbone. Oral and maxillofacial surgeons typically perform it for substantial jawbone loss, including severe atrophy that makes conventional implant support difficult. The operative report should identify the jaw treated, the extent reconstructed, and the subperiosteal implant approach.
Select this code for partial reconstruction; a complete reconstruction belongs to the corresponding complete-service code. Documentation should distinguish a subperiosteal implant from an endosteal implant and describe the treated anatomy and extent. The service 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 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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.
21245 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $1,217.40 | $834.38 |
How the 21245 rate is calculated
Each of 21245’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 · 21245
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.79Practice expense 23.87Malpractice 1.85
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21245
21245 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21245
Jaw 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) | 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 · 21245
Jaw 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
21245 without 51 · national office
$1,286.27
Jaw reconstruction
21245-51 · Second procedure: 50%
$643.14
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%).
21245 compared with similar codes
Compare codes
21245 vs 21246 vs 21248 vs 21244: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21246Jaw reconstruction
- Both describe subperiosteal implant reconstruction; 21245 is partial, while 21246 is complete.
- 21248Jaw reconstruction
- 21245 is for partial reconstruction with a subperiosteal implant. 21248 is for partial reconstruction with an endosteal implant.
- 21244Jaw reconstruction
- 21244 describes mandibular reconstruction with bone graft using a different approach; 21245 is partial reconstruction with a subperiosteal implant.
21245 billing questions
How does this differ from 21246?
21245 is for partial subperiosteal implant reconstruction. The corresponding complete reconstruction is reported with 21246.
How does this differ from 21248?
21245 describes a partial subperiosteal implant reconstruction; 21248 is for partial reconstruction using an endosteal implant.
Should modifier 50 be reported for both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What documentation supports reporting 21245?
The operative report should identify the mandible or maxilla treated, the partial extent of reconstruction, and the use of a subperiosteal implant.
Can an assistant surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code under the listed CMS rules.
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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