Billing code 21195: Jaw reconstructionMedicare rate & RVUs in Utah
Reconstructive surgery of the lower jaw without fixation is reported when the operative work rebuilds the mandible without fixation.
CMS doesn’t publish an office rate for 21195 in Utah.
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 21195 covers
This code describes reconstructive surgery of the mandible, the lower jaw, performed without fixation. Oral and maxillofacial surgeons and other surgeons who perform craniofacial reconstruction may use it for operative repair of a mandibular defect or deformity. The operative report should make clear that the work reconstructs the lower jaw and that fixation is not part of the reported service; routine dental treatment or a procedure limited to another facial bone is not this service.
Report the code when the documented reconstruction matches these features. 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 50% multiple-procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. An assistant at surgery may be paid; 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.
21195 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $1,178.05 |
How the 21195 rate is calculated
Each of 21195’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 · 21195
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.68Practice expense 15.06Malpractice 2.71
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21195
21195 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21195
Jaw reconstruction
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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 · 21195
Jaw reconstruction
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
21195 without 51 · national facility
$1,217.46
Jaw reconstruction
21195-51 · Second procedure: 50%
$608.73
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%).
21195 compared with similar codes
Compare codes
21195 vs 21193 vs 21194 vs 21196: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21193Mandibular reconstruction
- 21193 identifies lower-jaw reconstruction without a graft. Use 21195 when the documented distinction is reconstruction without fixation.
- 21194Mandible reconstruction
- 21194 identifies lower-jaw reconstruction with a graft. Use 21195 when the documented distinction is reconstruction without fixation.
- 21196Mandibular reconstruction
- 21196 is the neighboring fixation option. The operative report should distinguish reconstruction performed with fixation from reconstruction without it.
21195 billing questions
How does this differ from 21193 or 21194?
Those neighboring codes distinguish lower-jaw reconstruction by graft use: 21193 without a graft and 21194 with a graft. Choose based on the documented procedure and the code descriptor that matches it.
Can modifier 50 be used for bilateral work?
The code is already priced as bilateral, so modifier 50 does not increase payment.
Can an assistant surgeon be reported?
CMS allows payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
What happens if another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% 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 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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