$881.74–$956.01
21076 describes custom preparation of a surgical obturator for a maxillary defect. Use 21081 for a mandibular resection prosthesis.
On this page
CMS RVU26D · Effective 2026-10-01
21081 Mandibular prosthesis Medicare reimbursement rates in Pennsylvania
Reports impression-taking and custom preparation of a prosthesis for a patient with a mandibular resection, rather than an obturator or other facial prosthesis. Compare 21081 office and facility rates across CMS payment localities in Pennsylvania.
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 21081 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$1525.10–$1653.99
2 of 2 localities have a supported rate.
Facility setting
$1041.86–$1106.01
2 of 2 localities have a supported rate.
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.
Maxillofacial prosthetics
About 21081: Mandibular resection prosthesis preparation
Reports impression-taking and custom preparation of a prosthesis for a patient with a mandibular resection, rather than an obturator or other facial prosthesis.
A maxillofacial prosthodontist or other qualified clinician uses this service to take an impression and custom-prepare a prosthesis for a patient with a surgically resected portion of the mandible. The work is associated with reconstruction or prosthetic management after jaw resection and may be performed in a hospital-based service or a clinical prosthetics setting. The clinical record should identify the mandibular defect and the prosthesis being prepared.
Select this code for the mandibular resection prosthesis, not an obturator for a palatal or maxillary defect. Document the resection site, impression work, and customization performed. CMS assigns a 90-day global period, which 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 the others at 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate for this descriptor and anatomy.
CMS billing rules for 21081
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU22.28 · 47%
- Practice expense (office) RVU22.71 · 48%
- Malpractice RVU2.68 · 6%
335
Medicare services in 2024 · #3902 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.
21081 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$1,458.83–$1,580.37
21079 is for an interim obturator. It does not describe preparation of a mandibular resection prosthesis.
$1,657.52–$1,796.76
21080 is for a definitive obturator; 21081 is for a prosthesis associated with mandibular resection.
$1,433.32–$1,556.37
21082 describes a palatal augmentation prosthesis. Choose 21081 when the custom-prepared prosthesis is for mandibular resection.
Compare 21081 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$1653.99
Facility
$1106.01
Rest Of Pennsylvania →
Office / nonfacility
$1525.10
Facility
$1041.86
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21081 billing questions
When should I choose 21081 instead of an obturator code?
Use 21081 for impression and custom preparation of a prosthesis for a mandibular resection. Obturator codes describe prostheses for defects requiring an obturator, not a mandibular resection prosthesis.
What documentation supports 21081?
Document the mandibular resection defect, the planned mandibular prosthesis, and the impression and custom preparation performed.
Does 21081 have a global period?
Yes. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care.
Can I append modifier 50?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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 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.
1,86221077,,Impres&prep orbital prosth,A,,32.86,29.07,,9.15,,3.75,65.68,45.76,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86321079,,Impres&prep intrm obt prosth,A,,21.75,21.26,,6.72,,2.55,45.56,31.02,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86421080,,Impres&prep def obt prosth,A,,24.43,24.45,,7.48,,2.91,51.79,34.82,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86521081,,Impres&prep mndbl res prosth,A,,22.28,22.71,,6.95,,2.68,47.67,31.91,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86621082,,Impres&prep paltl aug prosth,A,,20.32,22.14,,7.02,,2.40,44.86,29.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86721083,,Impres&prep paltl lft prosth,A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86821084,,Impres&prep sp aid prosth,A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00