$4,243.75
21215 describes mandibular bone grafting. Use 21255 when the documented service is reconstruction of lower-jaw bone rather than grafting alone.
On this page
CMS RVU26D · Effective 2026-10-01
21255 Jaw reconstruction Medicare reimbursement rates in Rhode Island
Reports reconstructive surgery to restore lower-jaw bone anatomy, such as repair of a mandibular defect following trauma or disease. Compare 21255 office and facility rates across CMS payment localities in Rhode Island.
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 21255 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1240.73
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Oral and maxillofacial surgery
About 21255: Mandibular bone reconstruction
Reports reconstructive surgery to restore lower-jaw bone anatomy, such as repair of a mandibular defect following trauma or disease.
This service reconstructs bone of the mandible to address a defect or deformity affecting the lower jaw. Typical clinical situations include restoring mandibular bone after traumatic injury or disease-related bone loss. Oral and maxillofacial surgeons and other reconstructive surgeons may perform the operation in a hospital or ambulatory surgical setting. The operative report should identify the mandibular site, the defect and its cause, and the reconstructive work performed.
Select this code when the documented service is reconstruction of lower-jaw bone, rather than a separately described grafting procedure or surgery directed at the jaw joint. The 90-day global period 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 other procedures are subject to the standard multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 21255
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.00 · 49%
- Practice expense (office) RVU15.95 · 44%
- Malpractice RVU2.61 · 7%
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.
21255 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Both concern mandibular reconstruction, but 21244 has a distinct procedure description. Compare that description with the operative technique before selecting a code.
21247
No office rateLower jaw reconstruction
This is another lower-jaw reconstruction code with a distinct specified service. Choose based on the procedure documented, not the shared anatomic area.
No office rate
21240 addresses reconstruction of the temporomandibular joint. This code describes reconstruction of lower-jaw bone rather than surgery directed at the joint.
Compare 21255 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1240.73
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21255 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
1,929
- Code
- 21255
- Physician work
- 18.00
- Practice expense
- 15.95
- Malpractice
- 2.61
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.00 | × 1.019 | 18.3420 |
| Practice expense | 15.95 | × 1.033 | 16.4763 |
| Malpractice | 2.61 | × 0.892 | 2.3281 |
| Total RVUs | 37.1465 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1240.73
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18 | 1.019 |
| Practice expense | 15.95 | 1.033 |
| Malpractice | 2.61 | 0.892 |
(18 × 1.019 + 15.95 × 1.033 + 2.61 × 0.892) × $33.4009 = $1240.73
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21255 billing questions
How is this different from mandibular bone grafting?
This code describes reconstruction of lower-jaw bone. Code 21215 is for mandibular bone grafting; choose based on the specific service documented and the applicable full code description.
What documentation supports reporting this code?
The operative report should describe the mandibular defect, its location and cause, and the reconstruction performed. Include the relevant technique and materials when documented.
Does the 90-day global period include postoperative care?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
How should bilateral surgery be reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
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.
1,92621247,,Reconstruct lower jaw bone,A,,23.76,15.28,NA,15.28,,3.45,42.49,42.49,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92721248,,Reconstruction of jaw,A,,12.42,16.71,,7.79,,1.51,30.64,21.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92821249,,Reconstruction of jaw,A,,18.30,21.44,,9.64,,2.31,42.05,30.25,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92921255,,Reconstruct lower jaw bone,A,,18.00,15.95,NA,15.95,,2.61,36.56,36.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93021256,,Reconstruction of orbit,A,,17.22,12.97,NA,12.97,,3.19,33.38,33.38,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93121260,,Revise eye sockets,A,,17.45,16.80,NA,16.80,,3.23,37.48,37.48,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93221261,,Revise eye sockets,A,,33.22,25.75,NA,25.75,,6.17,65.14,65.14,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537