Billing code 21248: Jaw reconstructionMedicare rate & RVUs in Utah
Reconstructs part of the mandible or maxilla with an implant placed in the jawbone, generally to support restoration of a missing or deficient segment.
Medicare pays $984.77 for 21248 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 21248 covers
This procedure reconstructs a partial area of the mandible or maxilla by placing an endosteal implant within the jawbone to support oral rehabilitation. Oral and maxillofacial surgeons commonly perform it; other surgeons with the appropriate training may perform it in an office or surgical facility. The operative report should establish the jaw involved, the partial extent of reconstruction, and the implant work performed.
Report this code for partial reconstruction; use 21249 when the documented reconstruction is complete. 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code. CMS does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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.
21248 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $984.77 | $704.71 |
How the 21248 rate is calculated
Each of 21248’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 · 21248
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.42Practice expense 16.71Malpractice 1.51
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21248
21248 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21248
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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 21248
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
21248 without 51 · national office
$1,023.40
Jaw reconstruction
21248-51 · Second procedure: 50%
$511.70
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%).
21248 compared with similar codes
Compare codes
21248 vs 21249 vs 21244 vs 21215: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21249Jaw reconstruction
- 21248 describes partial jaw reconstruction with an endosteal implant; 21249 is the complete-reconstruction counterpart.
- 21244Jaw reconstruction
- 21244 describes mandibular reconstruction using a transosteal bone plate. Choose 21248 when the documented reconstruction uses an endosteal implant instead.
- 21215Bone graft
- 21215 reports mandibular bone grafting, not endosteal implant reconstruction. It may be relevant when a separate graft is performed during the same operative session.
21248 billing questions
How do I choose between 21248 and 21249?
Use 21248 for partial jaw reconstruction and 21249 for complete reconstruction. The operative documentation should support the extent performed.
Can I append modifier 50 for implants on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
Does the 90-day global include postoperative visits?
It includes related postoperative care for 90 days, as well as the day-before preoperative visit.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What should the operative report document?
Document the mandible or maxilla treated, why reconstruction was needed, the partial extent of reconstruction, and the endosteal implant work performed.
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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