$690.64
Both involve external fixation, but 21454 is open treatment and 21452 is percutaneous treatment. Follow the operative approach documented.
On this page
CMS RVU26D · Effective 2026-10-01
21454 Mandibular fracture repair Medicare reimbursement rates in Oklahoma
Report 21454 for open surgical treatment of a mandibular fracture when the fracture is reduced and stabilized with an external fixation device. Compare 21454 office and facility rates across CMS payment localities in Oklahoma.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 21454 in Oklahoma?
Oklahoma has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$424.85
1 of 1 localities have a supported rate.
Payment area: Oklahoma
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Oral surgery
About 21454: Open mandibular fracture treatment with external fixation
Report 21454 for open surgical treatment of a mandibular fracture when the fracture is reduced and stabilized with an external fixation device.
An oral and maxillofacial surgeon or other facial trauma surgeon uses an open approach to reduce a broken mandible and stabilize it with an external fixation device. The device uses fixation points secured to bone and a frame outside the face to hold the fracture in position. This approach may be selected when the surgeon determines external stabilization is appropriate for the fracture and patient. The service is generally performed in a hospital or other surgical facility.
Report 21454 when the operative documentation supports open treatment and external fixation, rather than percutaneous treatment or another fixation method. The note should identify the mandibular fracture, describe the open approach and reduction, and document the external fixation used. The 90-day global period includes 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 for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 21454
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.18 · 53%
- Practice expense (office) RVU5.49 · 41%
- Malpractice RVU0.82 · 6%
17
Medicare services in 2024 · #5991 by national volume
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.
21454 compared with similar codes
Office rates for Oklahoma, from the same CMS release.
$1,627.00
21461 describes open mandibular fracture treatment without interdental fixation. Use 21454 when the documented stabilization is external fixation.
$1,849.17
21462 describes open treatment with interdental fixation. 21454 identifies open treatment using an external fixation device.
No office rate
21470 is for complicated mandibular fractures treated through multiple surgical approaches. 21454 identifies open treatment with external fixation.
Compare 21454 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Oklahoma →
Office / nonfacility
Unavailable
Facility
$424.85
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21454 in Oklahoma.
PPRRVU2026_Oct_nonQPP.csv
1,988
- Code
- 21454
- Physician work
- 7.18
- Practice expense
- 5.49
- Malpractice
- 0.82
GPCI2026.csv
86
- Locality
- Oklahoma
- Physician work
- 1.000
- Practice expense
- 0.893
- Malpractice
- 0.777
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.18 | × 1.000 | 7.1800 |
| Practice expense | 5.49 | × 0.893 | 4.9026 |
| Malpractice | 0.82 | × 0.777 | 0.6371 |
| Total RVUs | 12.7197 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Oklahoma$424.85
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.18 | 1 |
| Practice expense | 5.49 | 0.893 |
| Malpractice | 0.82 | 0.777 |
(7.18 × 1 + 5.49 × 0.893 + 0.82 × 0.777) × $33.4009 = $424.85
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21454 billing questions
How does 21454 differ from 21452?
21454 describes open treatment with external fixation. 21452 is for percutaneous treatment with external fixation, so the documented surgical approach distinguishes them.
When should 21454 be chosen over 21461 or 21462?
Use 21454 when the mandible is treated through an open approach and stabilized externally. Codes 21461 and 21462 distinguish open treatment without or with interdental fixation.
Does the 90-day global period include postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be reported for fractures on both sides?
No. Modifier 50 is inappropriate for this code under the CMS bilateral rule.
When is an assistant surgeon payable?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment also requires supporting documentation, and team surgery is not permitted.
What documentation supports reporting 21454?
Document the mandibular fracture, the open approach and reduction, and the external fixation used to stabilize it. The operative note should make the approach and fixation method clear.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
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1,98721453,,Cltx mndblr fx ntrdntl fixj,A,,6.47,26.10,,19.25,,0.98,33.55,26.70,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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1,98921461,,Optx mndblr fx wo ntrdntl,A,,9.08,43.24,,18.66,,1.31,53.63,29.05,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99021462,,Optx mndblr fx w/ntrdntl,A,,10.73,48.58,,20.79,,1.61,60.92,33.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,99121465,,Optx mndblr cndylr fx,A,,12.79,7.42,NA,7.42,,1.46,21.67,21.67,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193