Billing code 21049: Maxillary cyst excisionMedicare rate & RVUs in Virginia
Reports removal of a maxillary cyst or benign lesion when the extent requires an extraoral approach, partial maxillary resection, and repair.
CMS doesn’t publish an office rate for 21049 in Virginia.
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 21049 covers
This service addresses a benign cyst or lesion of the upper jaw that requires an extraoral surgical approach and removal of part of the maxilla, with repair of the resulting defect. An oral and maxillofacial surgeon or another surgeon experienced in maxillary surgery may perform it in an operating room. The operative report should identify the maxillary lesion, the extraoral approach, the bone removed, and the repair performed.
Select this code for the documented extent of maxillary excision and repair, rather than a less extensive removal or a procedure on the mandible. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires 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.
Where 21049 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $1,119.44 |
| Virginia | Unavailable | $991.64 |
How the 21049 rate is calculated
Each of 21049’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 · 21049
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.84Practice expense 9.27Malpractice 2.46
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21049
21049 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21049
Maxillary cyst excision
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 21049
Maxillary cyst excision
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 51 · payment effect
With and without the modifier
21049 without 51 · national facility
$1,021.07
Maxillary cyst excision
21049-51 · Second procedure: 50%
$510.54
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21049 compared with similar codes
Compare codes
21049 vs 21048 vs 21030 vs 21047 vs 21034: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21048Maxillary excision
- 21048 is for a maxillary benign cyst or lesion excision requiring an intraoral osteotomy. Choose 21049 when the operative extent requires an extraoral approach, partial maxillary resection, and repair.
- 21030Bone lesion excision
- 21030 describes maxillary benign cyst or tumor removal by enucleation and curettage. It is not the choice for the more extensive maxillary resection and repair represented by 21049.
- 21047Jaw cyst excision
- 21047 concerns an extensive benign cyst or tumor excision of the mandible. 21049 is for the corresponding upper-jaw site.
- 21034Tumor excision
- 21034 is for a malignant tumor of the maxilla or zygoma. 21049 is for a benign cyst or lesion requiring extensive maxillary removal and repair.
21049 billing questions
How does this differ from 21048?
Use 21049 when the documented maxillary excision requires an extraoral approach, partial maxillary resection, and repair. 21048 describes a less extensive maxillary cyst or benign-lesion excision requiring an intraoral osteotomy.
Can the cyst removal and repair be reported separately?
The repair is part of the service described by this code. The operative documentation should show the lesion removal, extent of bone resection, and repair.
Should modifier 50 be appended for bilateral disease?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does the 90-day global period affect follow-up visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is submitted; team surgery is not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
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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