CPT 21485: TMJ reductionMedicare rate & RVUs in Utah
Reports closed reduction of a complicated temporomandibular joint dislocation, such as a recurrent displacement requiring fixation or splinting.
Medicare pays $949.97 for 21485 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 21485 covers
This service treats a displaced mandibular condyle without open surgery. A surgeon, commonly an oral and maxillofacial surgeon or another clinician experienced in jaw procedures, repositions the condyle and may use stabilization such as intermaxillary fixation or a splint for a complicated or recurrent dislocation. The service may occur in a hospital or outpatient surgical setting, depending on the patient’s needs and the complexity of reduction.
Choose this code when the record supports a complicated closed reduction, not a routine reduction captured by 21480 or an open procedure. Document the dislocation, why the reduction was complicated, the manipulation performed, and any fixation or splinting used. Medicare 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires medical-necessity documentation; 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.
21485 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $949.97 | $733.33 |
How the 21485 rate is calculated
Each of 21485’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 · 21485
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.65Practice expense 24.67Malpractice 0.67
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21485
21485 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21485
TMJ 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 · 21485
TMJ 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
21485 without 50 · national office
$1,001.69
TMJ reduction
21485-50 · Bilateral: 150%
$1,502.54
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).
21485 compared with similar codes
Compare codes
21485 vs 21480 vs 21490 vs 21451: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21480TMJ dislocation treatment
- Use 21480 for a routine closed reduction of a temporomandibular dislocation. Use 21485 when the closed treatment is complicated, such as recurrent displacement requiring fixation or splinting.
- 21490TMJ dislocation
- 21490 describes open operative treatment of a temporomandibular dislocation. This code is for closed reduction without an open approach.
- 21451Mandibular fracture
- 21451 treats a mandibular fracture, not a displaced temporomandibular joint. Select based on whether the diagnosis is a fracture or a joint dislocation.
21485 billing questions
When should 21485 be chosen over 21480?
Use 21485 when the closed reduction is complicated, such as a recurrent dislocation requiring fixation or splinting. A routine closed reduction is generally distinguished by 21480.
Does this code include fixation or splinting?
Fixation or splinting may be part of the complicated treatment described by 21485. Document the method and do not assume a separate fixation code is reportable for work included in the reduction.
How is bilateral treatment reported?
For bilateral dislocations treated in the same session, 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 reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are 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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