Billing code 21138: Forehead reductionMedicare rate & RVUs in Oregon
Reports forehead bone reduction and contouring with prosthetic material to restore or shape the forehead, including in craniofacial and gender-affirming surgery.
CMS doesn’t publish an office rate for 21138 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 21138 covers
This operation reduces and reshapes the forehead’s bony contour, with prosthetic material used as part of the reconstruction. It may be performed for prominent brow bossing or other forehead contour concerns, including during gender-affirming facial surgery. Craniofacial, plastic, or oral and maxillofacial surgeons may perform it in a hospital or other surgical setting. The operative report should make clear that forehead reduction and contouring were performed and describe the prosthetic material used in the reconstruction.
Choose this code when the documented procedure includes prosthetic material, rather than contouring alone or contouring with frontal sinus setback. The code has a 90-day global period: the day-before preoperative visit and related postoperative care through 90 days are included. For multiple procedures 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. An assistant at surgery 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.
Where 21138 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $849.93 |
| Rest Of Oregon | Unavailable | $802.14 |
How the 21138 rate is calculated
Each of 21138’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 · 21138
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.55Practice expense 9.86Malpractice 2.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21138
21138 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21138
Forehead reduction
| 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 · 21138
Forehead reduction
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
21138 without 51 · national facility
$826.67
Forehead reduction
21138-51 · Second procedure: 50%
$413.34
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%).
21138 compared with similar codes
Compare codes
21138 vs 21137 vs 21139 vs 21172 vs 21175: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21137Forehead reduction
- 21137 is for forehead contouring alone; 21138 includes prosthetic material in the reconstruction.
- 21139Forehead reconstruction
- 21139 describes forehead contouring with setback. Use 21138 when prosthetic material is part of the documented procedure instead.
- 21172Forehead reconstruction
- 21172 addresses reconstruction involving the supraorbital rims and lateral forehead; 21138 describes forehead contouring with prosthetic material.
- 21175Forehead reconstruction
- 21175 is for broader bifrontal and supraorbital reconstruction. Select 21138 for the forehead reduction and prosthetic reconstruction documented.
21138 billing questions
How does this differ from 21137?
21137 represents forehead contouring alone. Use 21138 when the documented forehead reconstruction also uses prosthetic material.
How does this differ from 21139?
21139 identifies forehead contouring with setback. This code is distinguished by prosthetic material; document the procedure actually performed.
What documentation supports reporting this code?
The operative report should describe the forehead reduction and contouring and identify the prosthetic material used in reconstruction.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
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.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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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