Billing code 21249: Jaw reconstructionMedicare rate & RVUs in Oklahoma
Reports complete reconstruction of the mandible or maxilla using endosteal implants, when the operative service addresses the full jaw rather than a partial extent.
Medicare pays $1,310.68 for 21249 in the office in Oklahoma (Oklahoma). 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 21249 covers
This service reconstructs the mandible or maxilla with implants placed within the jawbone to support dental restoration. Oral and maxillofacial surgeons commonly perform it for patients who need complete jaw rehabilitation, such as extensive tooth loss or loss of jaw support. The operative report should identify the jaw treated, the endosteal implant approach, and the full extent of reconstruction. The complete level is distinguished from the partial service by the extent treated, not simply by the number of implants.
Report the code when the documented procedure is complete endosteal implant reconstruction, rather than partial reconstruction or a different implant method. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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. Assistant-at-surgery payment requires documented medical necessity; 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.
21249 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $1,310.68 | $958.72 |
How the 21249 rate is calculated
Each of 21249’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 · 21249
RVUs × geographic indexes × conversion factor
Work18.30
18.30 RVUs× 1.000 GPCI
Practice expense21.44
21.44 RVUs× 1.000 GPCI
Malpractice2.31
2.31 RVUs× 1.000 GPCI
Adjusted RVUs
42.0500
Conversion factor
$33.4009
Medicare rate
$1,404.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21249
21249 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21249
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) | 0 | Not paid without supporting documentation. |
| 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 · 21249
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
21249 without 51 · national office
$1,404.51
Jaw reconstruction
21249-51 · Second procedure: 50%
$702.26
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%).
21249 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21248Jaw reconstruction
- Both use an endosteal implant approach. The distinction is the documented extent: complete for 21249 and partial for 21248.
- 21246Jaw reconstruction
- Both represent complete jaw reconstruction, but 21246 uses a subperiosteal implant approach; 21249 uses endosteal implants.
- 21215Bone graft
- 21215 addresses bone grafting of the mandible. This code describes complete endosteal implant-based jaw reconstruction, not bone grafting alone.
21249 billing questions
How does this code differ from 21248?
Both describe endosteal implant reconstruction of the mandible or maxilla. Use 21249 when the documented reconstruction is complete; 21248 represents the partial extent.
How is this different from subperiosteal implant reconstruction?
This code is for an endosteal approach, with implants placed within the jawbone. Codes 21245 and 21246 describe subperiosteal implant reconstruction, with partial and complete extents, respectively.
Does the 90-day global include postoperative visits?
Related postoperative care through the 90-day global period is included, as is the day-before preoperative visit.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
When is an assistant-at-surgery claim payable?
CMS allows assistant-at-surgery payment only when medical necessity is documented.
Can this code be reported with another procedure performed in the same session?
When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
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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