Billing code 21296: Jaw contouringMedicare rate & RVUs in Oregon
Reports surgery that reduces the masseter muscle and mandibular bone together, commonly to address prominent lower-face contour associated with masseter hypertrophy.
CMS doesn’t publish an office rate for 21296 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 21296 covers
This operation reduces the bulk of the masseter muscle and removes or reshapes mandibular bone, commonly along the lower jaw angle, during the same surgical service. It may be performed for prominent lower-face contour associated with benign masseter hypertrophy. Oral and maxillofacial surgeons and plastic surgeons typically perform the procedure in an operating room, using an approach suited to the planned muscle and bone work.
Report the code when the operative record supports reduction of both the masseter and mandibular bone; isolated muscle reduction is a different service. Documentation should identify the treated side or sides and describe the muscle and bone work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral reporting with modifier 50, CMS pays at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures at 50%. 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.
Where 21296 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $387.79 |
| Rest Of Oregon | Unavailable | $362.33 |
How the 21296 rate is calculated
Each of 21296’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 · 21296
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.66Practice expense 5.74Malpractice 0.67
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21296
21296 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21296
Jaw contouring
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 21296
Jaw contouring
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 50 · payment effect
With and without the modifier
21296 without 50 · national facility
$369.75
Jaw contouring
21296-50 · Bilateral: 150%
$554.63
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21296 compared with similar codes
Compare codes
21296 vs 21295 vs 21244 vs 21299: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21295Masseter reduction
- Choose 21295 for masseter reduction alone. The code here describes reduction of the masseter together with mandibular bone.
- 21244Jaw reconstruction
- 21244 describes mandibular reconstruction, not the combined masseter and bone reduction addressed here.
- 21299Unlisted cranfcl&maxlfcl px
- Use 21299 for a craniofacial procedure that lacks a specific listed code; use 21296 when the documented combined muscle and bone service fits.
21296 billing questions
How does this differ from 21295?
21296 includes reduction of both the masseter muscle and mandibular bone. Use 21295 when the documented service reduces the masseter muscle without mandibular bone reduction.
Can the muscle and bone work be reported separately?
This code represents the combined muscle and bone reduction. Do not separately report 21295 for the same masseter reduction included in that combined service.
How is bilateral work reported?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports reporting this code?
The operative report should establish that both the masseter and mandibular bone were reduced and identify the side or sides treated. A record describing muscle reduction alone supports consideration of 21295 instead.
Can an assistant or another surgeon be paid for this procedure?
CMS pays an assistant at surgery only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
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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