No office rate
21193 describes lower-jaw reconstruction without graft. Use 21199 when the documented reconstructive work includes advancement.
On this page
CMS RVU26D · Effective 2026-10-01
21199 Mandibular reconstruction Medicare reimbursement rates in Utah
Reports reconstructive surgery that advances the lower jaw to address mandibular deformity, such as a jaw-position problem requiring operative correction. Compare 21199 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 21199 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
$881.16
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 21199: Mandibular reconstruction with advancement
Reports reconstructive surgery that advances the lower jaw to address mandibular deformity, such as a jaw-position problem requiring operative correction.
This code describes reconstructive surgery that advances the mandible, moving the lower jaw forward as part of correcting its position or form. Oral and maxillofacial surgeons and other surgeons with craniofacial expertise typically perform the operation in a hospital or ambulatory surgical setting. Clinical contexts can include significant mandibular deficiency or deformity associated with congenital or developmental conditions; the operative plan and documented work determine whether advancement reconstruction is the service performed.
Report the code when the documented reconstruction includes advancement of the lower jaw, rather than selecting a related code solely because it involves the mandible. The operative report should identify the deformity, the advancement performed, and the reconstruction’s extent. The service has 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. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21199
- 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 RVU16.31 · 60%
- Practice expense (office) RVU8.45 · 31%
- Malpractice RVU2.37 · 9%
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.
21199 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
21194 describes lower-jaw reconstruction with graft. The advancement feature distinguishes 21199; select based on the actual operative work.
No office rate
21196 describes lower-jaw reconstruction with fixation. Do not substitute it for 21199 when the defining documented service is advancement.
Compare 21199 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
$881.16
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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 21199 in Utah.
PPRRVU2026_Oct_nonQPP.csv
1,912
- Code
- 21199
- Physician work
- 16.31
- Practice expense
- 8.45
- Malpractice
- 2.37
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.31 | × 1.000 | 16.3100 |
| Practice expense | 8.45 | × 0.940 | 7.9430 |
| Malpractice | 2.37 | × 0.898 | 2.1283 |
| Total RVUs | 26.3813 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$881.16
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.31 | 1 |
| Practice expense | 8.45 | 0.94 |
| Malpractice | 2.37 | 0.898 |
(16.31 × 1 + 8.45 × 0.94 + 2.37 × 0.898) × $33.4009 = $881.16
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.
21199 billing questions
How is 21199 distinguished from other lower-jaw reconstruction codes?
The key distinction is that 21199 describes reconstruction with advancement. Compare the operative work with codes describing reconstruction without graft, with graft, or with fixation.
Does modifier 50 apply when both sides of the jaw are treated?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What postoperative care is included in the global period?
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 reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 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 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.
1,90921195,,Reconst lwr jaw w/o fixation,A,,18.68,15.06,NA,15.06,,2.71,36.45,36.45,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91021196,,Reconst lwr jaw w/fixation,A,,20.31,15.56,NA,15.56,,2.95,38.82,38.82,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91121198,,Reconstr lwr jaw segment,A,,15.32,9.88,NA,9.88,,2.01,27.21,27.21,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91221199,,Reconstr lwr jaw w/advance,A,,16.31,8.45,NA,8.45,,2.37,27.13,27.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91321206,,Reconstruct upper jaw bone,A,,15.20,9.19,NA,9.19,,1.76,26.15,26.15,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91421208,,Augmentation of facial bones,A,,11.13,37.17,,7.64,,1.31,49.61,20.08,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91521209,,Reduction of facial bones,A,,7.62,15.46,,8.02,,0.93,24.01,16.57,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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