No office rate
21431 is closed treatment of a craniofacial separation. Choose 21433 for complicated open repair through multiple approaches.
On this page
CMS RVU26D · Effective 2026-10-01
21433 Craniofacial repair Medicare reimbursement rates in Vermont
Reports complicated open repair of a LeFort III-type craniofacial separation when the surgeon uses multiple operative approaches to treat the injury. Compare 21433 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 21433 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
$1442.77
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 21433: Complicated craniofacial separation repair
Reports complicated open repair of a LeFort III-type craniofacial separation when the surgeon uses multiple operative approaches to treat the injury.
This code describes open repair of a severe craniofacial separation of the LeFort III type using multiple operative approaches. The surgeon exposes and realigns the separated facial skeleton and stabilizes the repair as clinically required. Oral and maxillofacial surgeons, plastic surgeons, and other surgeons with craniofacial expertise may perform this operation, generally in a hospital operating room after major facial trauma.
Choose this code when the documented injury and operation support complicated open treatment through multiple approaches; the operative report should establish the fracture pattern, complexity, approaches used, and repair performed. It has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21433
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU25.63 · 56%
- Practice expense (office) RVU15.31 · 34%
- Malpractice RVU4.76 · 10%
23
Medicare services in 2024 · #5831 by national volume
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.
21433 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
21432 describes open treatment with wiring. Code 21433 is for complicated multiple-approach repair, not simply the use of wiring.
No office rate
21435 identifies complicated open treatment with internal and/or external fixation. Code 21433 distinguishes complicated treatment using multiple approaches.
No office rate
21436 is the multiple-approach sibling that specifies internal fixation. Use 21433 when that specific internal-fixation distinction is not the basis for code selection.
Compare 21433 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
$1442.77
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 21433 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,979
- Code
- 21433
- Physician work
- 25.63
- Practice expense
- 15.31
- Malpractice
- 4.76
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.63 | × 1.000 | 25.6300 |
| Practice expense | 15.31 | × 0.990 | 15.1569 |
| Malpractice | 4.76 | × 0.506 | 2.4086 |
| Total RVUs | 43.1955 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1442.77
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.63 | 1 |
| Practice expense | 15.31 | 0.99 |
| Malpractice | 4.76 | 0.506 |
(25.63 × 1 + 15.31 × 0.99 + 4.76 × 0.506) × $33.4009 = $1442.77
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.
21433 billing questions
When should this code be selected instead of 21431?
Use 21433 for complicated open repair of a LeFort III-type separation involving multiple approaches. Code 21431 describes closed treatment of the separation.
How does this differ from 21432?
Code 21432 describes open treatment with wiring of the bones. For 21433, the documented procedure must support complicated treatment using multiple approaches.
What documentation supports reporting 21433?
The operative report should identify the LeFort III-type craniofacial separation, explain its complexity, and describe the multiple approaches and repair performed.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative care?
The 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.
1,97621423,,Optx palatal/max fx comp,A,,10.58,9.07,NA,9.07,,1.96,21.61,21.61,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97721431,,Cltx craniofacial separation,A,,7.70,10.79,NA,10.79,,0.88,19.37,19.37,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97821432,,Optx cranfcl sep w/wiring,A,,8.60,9.93,NA,9.93,,1.59,20.12,20.12,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97921433,,Optx cranfcl sep comp mlt,A,,25.63,15.31,NA,15.31,,4.76,45.70,45.70,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98021435,,Optx crnfc sep comp int&/xtr,A,,19.75,14.36,NA,14.36,,3.66,37.77,37.77,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98121436,,Optx crnfcl sep comp mlt int,A,,29.54,19.00,NA,19.00,,5.49,54.03,54.03,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,98221440,,Cltx mndblr/max alv ridge fx,A,,3.35,19.95,,14.18,,0.48,23.78,18.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,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