Billing code 21451: Mandibular fractureMedicare rate & RVUs in Texas
Report this service when a clinician restores alignment of a mandibular fracture by manipulating the fragments without surgically exposing the fracture.
Medicare pays $726.68–$811.28 for 21451 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 21451 covers
An oral and maxillofacial surgeon, plastic surgeon, or other qualified surgeon uses manipulation to realign a fractured mandible without surgically exposing the fracture site. Treatment may occur in a hospital or other surgical setting after facial trauma. The service is distinct from treating an alveolar ridge fracture or a temporomandibular joint dislocation.
Choose this code when the clinician documents active manipulation to restore fracture alignment; treatment without manipulation is a different service, and closed treatment with interdental fixation has its own code. The operative report should identify the mandibular fracture and describe the reduction. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. 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 21451 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
$726.68 to $811.28
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $811.28 | $629.64 |
| Beaumont | $726.68 | $570.45 |
| Brazoria | $771.65 | $601.52 |
| Dallas | $776.33 | $605.33 |
| Fort Worth | $770.84 | $601.57 |
| Galveston | $773.80 | $603.32 |
| Houston | $785.14 | $614.66 |
| Rest Of Texas | $748.57 | $585.64 |
How the 21451 rate is calculated
Each of 21451’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 · 21451
RVUs × geographic indexes × conversion factor
Work5.51
5.51 RVUs× 1.000 GPCI
Practice expense17.22
17.22 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
23.3500
Conversion factor
$33.4009
Medicare rate
$779.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21451
21451 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21451
Mandibular fracture
| 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 · 21451
Mandibular fracture
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
21451 without 51 · national office
$779.91
Mandibular fracture
21451-51 · Second procedure: 50%
$389.96
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%).
21451 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21450Mandibular fracture care
- 21450 is for closed treatment without manipulation; 21451 requires manipulation to restore fracture alignment.
- 21453Mandibular fracture care
- 21453 describes closed treatment with interdental fixation. Use 21451 when manipulation is performed without that fixation service.
- 21461Mandibular fracture repair
- 21461 is open treatment of a mandibular fracture without interdental fixation. Choose it when the fracture is surgically exposed and treated.
- 21462Mandibular fracture repair
- 21462 is open treatment with interdental fixation, rather than closed manipulation without surgical exposure.
21451 billing questions
How does this differ from 21450?
Use 21451 when the provider manipulates the mandibular fracture to restore alignment. Code 21450 describes closed treatment without manipulation.
When is 21453 more appropriate?
Use 21453 for closed mandibular fracture treatment with interdental fixation. Document the fixation method and treatment performed.
Can this be reported with an open-treatment code?
The codes describe different treatment approaches. If the surgeon exposes and treats the fracture operatively, select the appropriate open-treatment code rather than reporting this closed-treatment service for the same fracture treatment.
What documentation supports 21451?
Document the mandibular fracture, the manipulation performed to restore alignment, and the treatment approach. The record should make clear that the fracture was not surgically exposed.
How does the 90-day global period affect follow-up?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. CMS applies the standard multiple-procedure reduction when other procedures are performed in the same session.
Can an assistant surgeon be paid for this service?
Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeon or team-surgery payment 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 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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