Billing code 21295: Masseter reductionMedicare rate & RVUs in Utah
Reports surgical reduction of the masseter, commonly for documented muscle enlargement that causes lower-face prominence or asymmetry.
CMS doesn’t publish an office rate for 21295 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 21295 covers
This operation reduces masseter muscle bulk, most often to address masseteric hypertrophy associated with a broad or asymmetric lower face. It is performed by a surgeon, such as an oral and maxillofacial or plastic surgeon, in an operating-room setting. The operative report should identify the masseter as the treated structure and describe the reduction performed; treatment directed at the temporalis muscle is coded separately by its own code.
Report 21295 for the masseter reduction itself, supported by documentation of the clinical indication, treated side or sides, and operative work. It has a 90-day global period, which includes 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 at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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.
21295 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $177.28 |
How the 21295 rate is calculated
Each of 21295’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 · 21295
RVUs × geographic indexes × conversion factor
Work1.85
1.85 RVUs× 1.000 GPCI
Practice expense3.43
3.43 RVUs× 1.000 GPCI
Malpractice0.26
0.26 RVUs× 1.000 GPCI
Adjusted RVUs
5.5400
Conversion factor
$33.4009
Medicare rate
$185.04
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21295
21295 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21295
Masseter reduction
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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 · 21295
Masseter reduction
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 50 · payment effect
With and without the modifier
21295 without 50 · national facility
$185.04
Masseter reduction
21295-50 · Bilateral: 150%
$277.56
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21295 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21296Jaw contouring
- Choose 21295 for masseter reduction and 21296 for temporalis reduction; the operative report should identify which muscle was treated.
- 21025Bone excision
- 21295 describes reduction of masseter muscle bulk. 21025 describes excision of mandibular bone, so select it when the work removes bone.
- 21244Jaw reconstruction
- 21295 treats masseter muscle bulk; 21244 is for reconstruction of the lower jaw, not muscle reduction.
21295 billing questions
How does 21295 differ from 21296?
21295 is for reduction of the masseter muscle. Use 21296 when the operation reduces the temporalis muscle instead.
What documentation supports 21295?
Document the masseteric condition prompting surgery, the muscle treated, laterality, and the reduction performed in the operative report.
How is bilateral masseter reduction reported?
Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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