No office rate
Both address forehead reconstruction. Use the code whose full descriptor and graft method match the documented operation; this code specifies autograft reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
21180 Forehead reconstruction Medicare reimbursement rates in Utah
Reports reconstructive surgery of the forehead using the patient's own graft tissue when the operative work specifically includes autograft reconstruction. Compare 21180 office and facility rates across CMS payment localities in Utah.
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 21180 in Utah?
Utah 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
$1449.44
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Craniofacial surgery
About 21180: Forehead reconstruction with autograft
Reports reconstructive surgery of the forehead using the patient's own graft tissue when the operative work specifically includes autograft reconstruction.
A craniofacial surgeon, plastic surgeon, or neurosurgeon may use this service to rebuild forehead contour or structure with tissue taken from the patient. The operative plan and report should identify the forehead reconstruction performed and the autograft used. Cases may arise in craniofacial reconstruction after congenital deformity, trauma, or removal of abnormal tissue, when the surgeon determines autologous grafting is part of the repair.
Select this code when the documented reconstruction includes an autograft; distinguish it from nearby forehead codes by the anatomy treated and the graft technique described in the operative report. CMS classifies the procedure as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If other 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. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21180
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU24.94 · 56%
- Practice expense (office) RVU15.21 · 34%
- Malpractice RVU4.63 · 10%
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.
21180 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
This code concerns forehead reconstruction with autograft. Code 21172 is directed to reconstruction involving the superior-lateral orbital rim and lower forehead.
No office rate
Choose 21175 when the operation involves the bifrontal region, superior orbital rims, and lower forehead rather than the autograft forehead reconstruction described here.
Compare 21180 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
Utah →
Office / nonfacility
Unavailable
Facility
$1449.44
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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 21180 in Utah.
PPRRVU2026_Oct_nonQPP.csv
1,901
- Code
- 21180
- Physician work
- 24.94
- Practice expense
- 15.21
- Malpractice
- 4.63
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.94 | × 1.000 | 24.9400 |
| Practice expense | 15.21 | × 0.940 | 14.2974 |
| Malpractice | 4.63 | × 0.898 | 4.1577 |
| Total RVUs | 43.3951 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$1449.44
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.94 | 1 |
| Practice expense | 15.21 | 0.94 |
| Malpractice | 4.63 | 0.898 |
(24.94 × 1 + 15.21 × 0.94 + 4.63 × 0.898) × $33.4009 = $1449.44
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.
21180 billing questions
How does this differ from 21179?
Both concern forehead reconstruction. This code identifies autograft reconstruction; compare the complete code descriptions and operative technique when deciding between them.
Should modifier 50 be appended for both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting this code?
The operative report should describe the forehead reconstruction, the structural work performed, and the use of the patient's own graft tissue.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.
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.
1,89821172,,Rcnst supr-lat orb rm&lw fhd,A,,27.50,23.42,NA,23.42,,11.63,62.55,62.55,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,89921175,,Rcnst bfrnt sp orb rm&lw fhd,A,,32.72,19.04,NA,19.04,,6.08,57.84,57.84,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90021179,,Rcnstj forehead with grafts,A,,22.08,14.03,NA,14.03,,4.10,40.21,40.21,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90121180,,Rcnstj forehead w/autograft,A,,24.94,15.21,NA,15.21,,4.63,44.78,44.78,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90221181,,Rcnst cntrg b9 tum crnl xtrc,A,,10.02,8.26,NA,8.26,,1.86,20.14,20.14,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90321182,,Reconstruct cranial bone,A,,31.77,17.69,NA,17.69,,5.90,55.36,55.36,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90421183,,Reconstruct cranial bone,A,,34.81,18.81,NA,18.81,,6.46,60.08,60.08,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985