Billing code 21154: Midface reconstructionMedicare rate & RVUs in Oregon
Reports Le Fort III midface reconstruction without an interpositional bone graft, commonly performed to correct substantial midface deficiency or craniofacial skeletal deformity.
CMS doesn’t publish an office rate for 21154 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 21154 covers
This operation reconstructs the midface at the Le Fort III level, separating and repositioning the midfacial skeleton relative to the cranial base, then stabilizing it. Craniofacial, plastic, or oral and maxillofacial surgeons commonly perform it in a hospital setting for significant midface hypoplasia, including deformities associated with craniosynostosis. The code distinguishes this reconstruction from the advancement-specific codes and from the version that includes an interpositional bone graft.
Select the code from the documented operative technique: the record should identify the Le Fort III reconstruction and whether an interpositional bone graft was used. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate because the reconstruction treats the midface as a unit. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery billing 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 21154 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,708.02 |
| Rest Of Oregon | Unavailable | $1,627.45 |
How the 21154 rate is calculated
Each of 21154’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 · 21154
RVUs × geographic indexes × conversion factor
Work30.51
30.51 RVUs× 1.000 GPCI
Practice expense15.14
15.14 RVUs× 1.000 GPCI
Malpractice4.46
4.46 RVUs× 1.000 GPCI
Adjusted RVUs
50.1100
Conversion factor
$33.4009
Medicare rate
$1,673.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21154
21154 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21154
Midface 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) | 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 · 21154
Midface 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
21154 without 51 · national facility
$1,673.72
Midface reconstruction
21154-51 · Second procedure: 50%
$836.86
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%).
21154 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21155Midface reconstruction
- The Le Fort III reconstruction level is shared, but 21155 includes an interpositional bone graft; 21154 is selected when one is not used.
- 21159Midface reconstruction
- 21159 describes Le Fort III advancement without an interpositional graft. Use 21154 for the Le Fort III reconstruction when the documented procedure is not the advancement variant.
- 21160Midface reconstruction
- 21160 describes Le Fort III advancement with an interpositional bone graft; 21154 is the non-advancement reconstruction without that graft.
- 21150Midface reconstruction
- 21150 is a Le Fort II reconstruction involving anterior intrusion. 21154 is for reconstruction at the Le Fort III level.
21154 billing questions
How is 21154 distinguished from 21155?
Use 21154 for the Le Fort III reconstruction without an interpositional bone graft. The corresponding graft version is 21155.
When would 21159 or 21160 be considered instead?
Those codes describe Le Fort III advancement. Choose between them based on whether the documented advancement includes an interpositional bone graft.
Can modifier 50 be reported?
No. This is a reconstruction of the midface as a unit, not a separately reportable procedure on each side.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through the 90-day period.
How are assistant and co-surgeon claims handled?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team-surgery billing 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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