Billing code 21465: Mandibular fracture repairMedicare rate & RVUs in Utah
Report 21465 for open surgical treatment of a fracture involving the mandibular condyle, the part of the jaw that forms the temporomandibular joint.
CMS doesn’t publish an office rate for 21465 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 21465 covers
This service involves surgically exposing and realigning a fractured mandibular condyle, with fixation used when needed to stabilize the fragments. It is typically performed in an operating room by an oral and maxillofacial surgeon, or another surgeon qualified to treat facial fractures. The operative record should identify the condylar fracture and describe the open approach and treatment performed. A fracture managed without surgical exposure is not reported with this code.
Select 21465 for the open treatment of a condylar fracture, rather than a general mandibular fracture code or a code for closed management. Documentation should establish the fracture site and the surgical work; note fixation and any additional fracture procedures performed during the session. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one 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 may be available; co-surgeons are paid only with supporting documentation, and team surgery 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.
21465 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $703.95 |
How the 21465 rate is calculated
Each of 21465’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 · 21465
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.79Practice expense 7.42Malpractice 1.46
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21465
21465 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21465
Mandibular fracture repair
| 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) | 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 · 21465
Mandibular fracture repair
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
21465 without 50 · national facility
$723.80
Mandibular fracture repair
21465-50 · Bilateral: 150%
$1,085.70
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).
21465 compared with similar codes
Compare codes
21465 vs 21461 vs 21462 vs 21454 vs 21470: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21461Mandibular fracture repair
- Use 21465 when the open repair is specifically for a mandibular condylar fracture. Code 21461 describes open mandibular fracture treatment without interdental fixation.
- 21462Mandibular fracture repair
- 21462 describes open mandibular fracture treatment with interdental fixation. For an open condylar fracture, use the condylar-specific 21465.
- 21454Mandibular fracture repair
- 21454 describes open mandibular fracture treatment with external fixation. 21465 identifies open treatment of a condylar fracture.
- 21470Mandibular fracture repair
- 21470 is for complicated mandibular fracture treatment involving multiple approaches. 21465 identifies the condylar fracture service.
21465 billing questions
How does 21465 differ from 21461 or 21462?
21465 identifies open treatment of a mandibular condylar fracture. Codes 21461 and 21462 describe open mandibular fracture treatment without the condylar-specific designation; 21462 includes interdental fixation.
Can 21465 be reported for a fracture treated without open surgery?
No. Use a code for the applicable closed or percutaneous treatment when the fracture is managed without open surgical exposure.
How should bilateral condylar fractures be reported?
When the service is bilateral, report modifier 50; CMS pays the bilateral procedure at 150%.
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 billed?
Assistant-at-surgery payment may be available. Co-surgeons are paid only when supporting documentation is submitted; team surgery 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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