Billing code 21196: Mandibular reconstructionMedicare rate & RVUs in Utah
Reports reconstruction of the mandibular rami, body, or angle when fixation is used to stabilize the reconstructed jaw.
CMS doesn’t publish an office rate for 21196 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 21196 covers
Code 21196 represents operative reconstruction of the mandibular rami, body, or angle with fixation to stabilize the reconstructed jaw. Oral and maxillofacial, plastic, or craniofacial surgeons may perform the procedure in a hospital or ambulatory surgery setting to address mandibular defects or deformity after trauma, tumor removal, or a congenital condition. The operative report should identify the reconstructed area, the clinical reason for reconstruction, the technique, and the fixation used; document grafting when relevant to choosing among mandibular reconstruction codes.
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 multiple procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is 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.
21196 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $1,255.39 |
How the 21196 rate is calculated
Each of 21196’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 · 21196
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 20.31Practice expense 15.56Malpractice 2.95
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21196
21196 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21196
Mandibular 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) | 1 | Permitted with supporting documentation. |
| 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 · 21196
Mandibular 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
21196 without 51 · national facility
$1,296.62
Mandibular reconstruction
21196-51 · Second procedure: 50%
$648.31
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%).
21196 compared with similar codes
Compare codes
21196 vs 21195 vs 21193 vs 21194: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21195Jaw reconstruction
- Use 21196 when fixation is part of the documented reconstruction; 21195 describes the corresponding reconstruction without fixation.
- 21193Mandibular reconstruction
- 21193 is the mandibular reconstruction variant specified without bone graft. Distinguish it from 21196 using the documented procedure and applicable descriptor.
- 21194Mandible reconstruction
- 21194 is the mandibular reconstruction variant specified with bone graft. Do not infer graft use solely from fixation documented for 21196.
21196 billing questions
How does 21196 differ from 21195?
Both describe reconstruction of the mandibular rami, body, or angle. Code 21196 is the fixation variant; 21195 describes reconstruction without fixation.
Does fixation alone distinguish 21196 from 21193 or 21194?
Codes 21193 and 21194 distinguish reconstruction without or with a bone graft, respectively. Choose based on the documented procedure and applicable descriptor, rather than assuming fixation establishes graft use.
Should modifier 50 be added for bilateral reconstruction?
CMS prices 21196 as bilateral, and modifier 50 does not increase payment.
What documentation supports reporting 21196?
Document the mandibular area reconstructed, the indication, the reconstructive technique, and the fixation used. Record grafting when performed and relevant to code selection.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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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