No office rate
Choose 21295 for masseter reduction and 21296 for temporalis reduction; the operative report should identify which muscle was treated.
On this page
CMS RVU26D · Effective 2026-10-01
21295 Masseter reduction Medicare reimbursement rates in Vermont
Reports surgical reduction of the masseter, commonly for documented muscle enlargement that causes lower-face prominence or asymmetry. Compare 21295 office and facility rates across CMS payment localities in Vermont.
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 21295 in Vermont?
Vermont 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
$179.61
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Maxillofacial surgery
About 21295: Masseter muscle reduction
Reports surgical reduction of the masseter, commonly for documented muscle enlargement that causes lower-face prominence or asymmetry.
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.
CMS billing rules for 21295
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.85 · 33%
- Practice expense (office) RVU3.43 · 62%
- Malpractice RVU0.26 · 5%
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 compared with similar codes
Office rates for Vermont, from the same CMS release.
$813.72
21295 describes reduction of masseter muscle bulk. 21025 describes excision of mandibular bone, so select it when the work removes bone.
No office rate
21295 treats masseter muscle bulk; 21244 is for reconstruction of the lower jaw, not muscle reduction.
Compare 21295 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
Vermont →
Office / nonfacility
Unavailable
Facility
$179.61
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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 21295 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,940
- Code
- 21295
- Physician work
- 1.85
- Practice expense
- 3.43
- Malpractice
- 0.26
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.85 | × 1.000 | 1.8500 |
| Practice expense | 3.43 | × 0.990 | 3.3957 |
| Malpractice | 0.26 | × 0.506 | 0.1316 |
| Total RVUs | 5.3773 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$179.61
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.85 | 1 |
| Practice expense | 3.43 | 0.99 |
| Malpractice | 0.26 | 0.506 |
(1.85 × 1 + 3.43 × 0.99 + 0.26 × 0.506) × $33.4009 = $179.61
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.
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 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.
1,93721275,,Revision orbitofacial bones,A,,11.47,9.28,NA,9.28,,2.13,22.88,22.88,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93821280,,Medial canthopexy,A,,6.95,8.04,NA,8.04,,0.71,15.70,15.70,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93921282,,Lateral canthopexy,A,,4.16,6.39,NA,6.39,,0.51,11.06,11.06,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94021295,,Revision of jaw muscle/bone,A,,1.85,3.43,NA,3.43,,0.26,5.54,5.54,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94121296,,Revision of jaw muscle/bone,A,,4.66,5.74,NA,5.74,,0.67,11.07,11.07,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94221299,,Unlisted cranfcl&maxlfcl px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94321315,,Clsd tx nsl fx mnpj wo stblj,A,,0.94,3.69,,0.51,,0.16,4.79,1.61,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817