Billing code 21048: Maxillary excisionMedicare rate & RVUs in Oregon
Reports removal of a complex benign cyst or tumor from the maxilla when an extraoral approach, osteotomy, and partial maxillectomy are performed.
CMS doesn’t publish an office rate for 21048 in Oregon.
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 21048 covers
This service removes a complex benign cyst or tumor from the upper jaw through an external approach, with bone division and partial removal of the maxilla. Oral and maxillofacial surgeons commonly perform it for extensive maxillary lesions, including an odontogenic cyst when its extent requires this operation. The operative report should identify the lesion and site and describe the external approach, osteotomy, and partial maxillectomy performed.
Choose this code based on the documented approach and extent of bone removal, not simply the presence of a cyst or tumor. A less extensive lesion treated by enucleation and curettage may fit 21040; an intraoral operation of this extent is represented by 21049. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is not appropriate for this service. Assistant-at-surgery payment requires documented medical necessity, 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.
Where 21048 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $940.42 |
| Rest Of Oregon | Unavailable | $887.90 |
How the 21048 rate is calculated
Each of 21048’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 · 21048
RVUs × geographic indexes × conversion factor
Work14.34
14.34 RVUs× 1.000 GPCI
Practice expense11.05
11.05 RVUs× 1.000 GPCI
Malpractice1.76
1.76 RVUs× 1.000 GPCI
Adjusted RVUs
27.1500
Conversion factor
$33.4009
Medicare rate
$906.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21048
21048 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21048
Maxillary excision
| 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) | 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 · 21048
Maxillary excision
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
21048 without 51 · national facility
$906.83
Maxillary excision
21048-51 · Second procedure: 50%
$453.42
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%).
21048 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21049Maxillary cyst excision
- This code represents the extraoral approach. Use 21049 when the complex maxillary lesion operation is performed through an intraoral approach.
- 21040Mandibular lesion excision
- 21040 describes enucleation and curettage of a benign maxillary or zygomatic lesion. Use 21048 when the documented operation includes an extraoral approach, osteotomy, and partial maxillectomy.
- 21046Mandibular lesion excision
- 21046 is the corresponding complex benign lesion operation on the mandible. This code is for the maxilla.
- 21030Bone lesion excision
- 21030 describes excision of a benign maxillary or zygomatic tumor without the specific complex extraoral osteotomy and partial maxillectomy represented by 21048.
21048 billing questions
How is 21048 distinguished from 21049?
Both represent complex maxillary lesion removal with osteotomy and partial maxillectomy. Choose 21048 for the extraoral approach and 21049 for the intraoral approach.
When would 21040 be more appropriate?
Use 21040 for a maxillary or zygomatic benign lesion treated by enucleation and curettage, rather than the more extensive osteotomy and partial maxillectomy represented by 21048.
What operative details support 21048?
Document the maxillary lesion and its location, the extraoral approach, the osteotomy, and the partial maxillectomy performed. The report should make the extent of the operation clear.
Are related postoperative visits included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other same-session procedures handled?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity, while co-surgeon payment requires supporting documentation. Team surgery is not permitted.
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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