No office rate
21175 describes a bifrontal reconstruction of the supraorbital rims and lower forehead. Select based on the anatomy and extent documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
21172 Forehead reconstruction Medicare reimbursement rates in Pennsylvania
Reconstructs the supraorbital rim and lower forehead, commonly to correct a craniofacial deformity requiring reshaping of the upper facial skeleton. Compare 21172 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 21172 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
No supported rate
Facility setting
$2003.72–$2212.80
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.
Craniofacial surgery
About 21172: Supraorbital rim and lower forehead reconstruction
Reconstructs the supraorbital rim and lower forehead, commonly to correct a craniofacial deformity requiring reshaping of the upper facial skeleton.
This operation reshapes the bony framework of the lower forehead and supraorbital rim. It is typically performed by a craniofacial, plastic, or oral and maxillofacial surgeon in an operating room, often for a congenital craniofacial deformity such as craniosynostosis. The surgeon’s operative report should identify the reconstructed anatomy and describe the bony work performed.
Report the code when the documented procedure matches reconstruction of the supraorbital rim and lower forehead, rather than a broader bifrontal reconstruction or a different forehead reconstruction. Medicare assigns a 90-day global period; the day-before preoperative visit and related postoperative care during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21172
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU27.50 · 44%
- Practice expense (office) RVU23.42 · 37%
- Malpractice RVU11.63 · 19%
35
Medicare services in 2024 · #5562 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.
21172 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
21179 is a forehead reconstruction code specifying grafts. This code is defined by reconstruction of the supraorbital rim and lower forehead.
No office rate
21180 specifies autograft use in forehead reconstruction. Choose it only when the documented procedure matches that graft-based service rather than this code’s anatomic description.
Compare 21172 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
Unavailable
Facility
$2212.80
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$2003.72
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21172 billing questions
How is this distinguished from 21175?
This code describes reconstruction of the supraorbital rim and lower forehead. Code 21175 identifies a bifrontal reconstruction involving the supraorbital rims and lower forehead; use the code matching the operative work documented.
Should modifier 50 be reported for both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
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.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What documentation supports this code?
The operative report should identify the supraorbital rim and lower forehead as the reconstructed anatomy and describe the bony reconstruction performed.
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.
1,89521155,,Rcnstj mdfc lefort iii w/i,A,,34.34,16.08,NA,16.08,,5.01,55.43,55.43,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89621159,,Rcnst mdfc lfrtiii advm wo i,A,,42.06,17.96,NA,17.96,,6.15,66.17,66.17,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89721160,,Rcnst mdfc lfrtiii advm w/i,A,,46.01,18.92,NA,18.92,,6.71,71.64,71.64,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89821172,,Rcnst supr-lat orb rm&lw fhd,A,,27.50,23.42,NA,23.42,,11.63,62.55,62.55,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89921175,,Rcnst bfrnt sp orb rm&lw fhd,A,,32.72,19.04,NA,19.04,,6.08,57.84,57.84,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90021179,,Rcnstj forehead with grafts,A,,22.08,14.03,NA,14.03,,4.10,40.21,40.21,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90121180,,Rcnstj forehead w/autograft,A,,24.94,15.21,NA,15.21,,4.63,44.78,44.78,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00