No office rate
Choose 21295 for masseter reduction alone. The code here describes reduction of the masseter together with mandibular bone.
On this page
CMS RVU26D · Effective 2026-10-01
21296 Jaw contouring Medicare reimbursement rates in Pennsylvania
Reports surgery that reduces the masseter muscle and mandibular bone together, commonly to address prominent lower-face contour associated with masseter hypertrophy. Compare 21296 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 21296 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
$352.80–$384.73
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 21296: Masseter and mandibular bone reduction
Reports surgery that reduces the masseter muscle and mandibular bone together, commonly to address prominent lower-face contour associated with masseter hypertrophy.
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.
CMS billing rules for 21296
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU4.66 · 42%
- Practice expense (office) RVU5.74 · 52%
- Malpractice RVU0.67 · 6%
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.
21296 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
21244 describes mandibular reconstruction, not the combined masseter and bone reduction addressed here.
21299
No office rateUnlisted 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.
Compare 21296 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
$384.73
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$352.80
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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 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.
1,93821280,,Medial canthopexy,A,,6.95,8.04,NA,8.04,,0.71,15.70,15.70,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93921282,,Lateral canthopexy,A,,4.16,6.39,NA,6.39,,0.51,11.06,11.06,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94021295,,Revision of jaw muscle/bone,A,,1.85,3.43,NA,3.43,,0.26,5.54,5.54,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94121296,,Revision of jaw muscle/bone,A,,4.66,5.74,NA,5.74,,0.67,11.07,11.07,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94221299,,Unlisted cranfcl&maxlfcl px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94321315,,Clsd tx nsl fx mnpj wo stblj,A,,0.94,3.69,,0.51,,0.16,4.79,1.61,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94421320,,Clsd tx nsl fx w/mnpj&stablj,A,,1.55,4.83,,0.67,,0.23,6.61,2.45,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00