CPT code 21421: Fracture fixation2026 Medicare rate & RVUs in Texas
Reports closed management of a palatal or maxillary fracture stabilized with interdental wiring, without surgically exposing the fracture site.
Medicare pays $618.67–$683.51 for 21421 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
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 21421 covers
This service manages a palatal or maxillary fracture by restoring alignment and stabilizing the injury with wires secured to the teeth. The fracture is treated without surgically exposing it. Oral and maxillofacial surgeons commonly perform this work, often in a hospital or other surgical setting, when the fracture pattern can be managed closed and dental fixation can maintain the intended position and occlusion.
Choose this code when the record supports closed reduction and interdental wire fixation of a palatal or maxillary fracture. Document the fracture site and pattern, the reduction and fixation performed, and the reason the approach was closed. The service has a 90-day global period, including 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 50% reduction. Modifier 50 is not appropriate. 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 21421 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$618.67 to $683.51
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $683.51 | $528.73 |
| Beaumont | $618.67 | $485.54 |
| Brazoria | $652.74 | $507.76 |
| Dallas | $656.87 | $511.16 |
| Fort Worth | $652.74 | $508.49 |
| Galveston | $654.69 | $509.41 |
| Houston | $666.77 | $521.49 |
| Rest Of Texas | $635.33 | $496.49 |
How the 21421 rate is calculated
Each of 21421’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 · 21421
RVUs × geographic indexes × conversion factor
Work5.87
5.87 RVUs× 1.000 GPCI
Practice expense13.23
13.23 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
19.7600
Conversion factor
$33.4009
Medicare rate
$660.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21421
21421 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21421
Fracture fixation
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 21421
Fracture fixation
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 51 · payment effect
With and without the modifier
21421 without 51 · national office
$660.00
Fracture fixation
21421-51 · Second procedure: 50%
$330.00
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21421 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21422Maxillary fracture repair
- Choose 21421 for closed reduction with interdental wire fixation. Choose 21422 when the fracture is treated open.
- 21423Fracture repair
- Code 21423 describes open treatment of a complicated palatal or maxillary fracture with multiple approaches; 21421 describes closed wire fixation.
- 21440Fracture treatment
- Code 21440 is for a fracture limited to the alveolar ridge. Use 21421 when the treated injury is a palatal or maxillary fracture managed with interdental wiring.
21421 billing questions
How is this code different from 21422?
This code describes closed fracture management with interdental wire fixation. Code 21422 is for open treatment of the palatal or maxillary fracture.
When would 21423 be more appropriate?
Use 21423 for open treatment of a complicated palatal or maxillary fracture involving multiple approaches. This code is for closed treatment with interdental wiring.
Can modifier 50 be reported?
No. Modifier 50 is not appropriate for this code; report the fracture treatment based on the documented service and anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
What documentation supports this code?
Document the palatal or maxillary fracture, closed reduction, and interdental wire fixation. The record should make clear that the fracture was not surgically exposed for treatment.
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.
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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