Billing code 21030: Bone lesion excisionMedicare rate & RVUs in Utah
Reports enucleation and curettage of a benign tumor or cyst involving the maxilla or zygoma, typically performed by an oral and maxillofacial surgeon.
Medicare pays $456.18 for 21030 in the office in Utah (Utah). 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 21030 covers
This service removes a benign tumor or cyst arising in the maxilla or zygoma by enucleating the lesion and curetting its bony site. Oral and maxillofacial surgeons commonly perform it for an intraosseous lesion identified on dental or facial imaging, with the specimen sent for pathologic examination. The approach and setting depend on the lesion and the patient; the defining work is enucleation and curettage, rather than resection of a malignant tumor or removal of a superficial facial mass.
Report the code when the operative record identifies a benign maxillary or zygomatic tumor or cyst and documents enucleation with curettage. A 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral reporting with modifier 50, CMS pays at 150%. Assistant-at-surgery payment is restricted; 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.
21030 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $456.18 | $325.25 |
How the 21030 rate is calculated
Each of 21030’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 · 21030
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.79Practice expense 8.87Malpractice 0.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21030
21030 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21030
Bone lesion excision
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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 · 21030
Bone lesion excision
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 50 · payment effect
With and without the modifier
21030 without 50 · national office
$475.96
Bone lesion excision
21030-50 · Bilateral: 150%
$713.94
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21030 compared with similar codes
Compare codes
21030 vs 21034 vs 21026 vs 21048 vs 21040: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21034Tumor excision
- Both concern the maxilla or zygoma, but 21030 describes enucleation and curettage of a benign lesion; 21034 is for a malignant tumor.
- 21026Facial bone excision
- Use 21030 for enucleation and curettage of a benign tumor or cyst in the maxilla or zygoma. Code 21026 describes excision of facial bone or bones.
- 21048Maxillary excision
- Code 21048 concerns a maxillary benign tumor or cyst requiring intraoral osteotomy. Code 21030 describes enucleation and curettage.
- 21040Mandibular lesion excision
- Code 21040 describes enucleation and curettage of a benign tumor or cyst in the mandible; 21030 is for the maxilla or zygoma.
21030 billing questions
How does this differ from code 21034?
Code 21030 is for enucleation and curettage of a benign maxillary or zygomatic tumor or cyst. Code 21034 is for excision of a malignant tumor in those bones.
When would code 21026 be a better fit?
Code 21026 describes excision of facial bone or bones. Use 21030 when the documented service is enucleation and curettage of a benign tumor or cyst specifically involving the maxilla or zygoma.
Is the related postoperative care included?
Yes. 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?
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.
Can an assistant surgeon or co-surgeon be billed?
CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
What should the operative documentation establish?
Document the maxillary or zygomatic site, the benign tumor or cyst, and the enucleation and curettage performed. The record should distinguish this work from malignant tumor excision or a different bone-removal procedure.
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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