Billing code 21147: Midface reconstructionMedicare rate & RVUs in Washington
Reconstructs the maxilla through a LeFort I osteotomy in three or more segments with bone grafting for complex midface deformity correction.
CMS doesn’t publish an office rate for 21147 in Washington.
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 21147 covers
This service reconstructs the midface by mobilizing the maxilla with a LeFort I osteotomy, dividing it into three or more pieces, and using bone grafting as part of the reconstruction. Oral and maxillofacial surgeons, plastic surgeons, or craniofacial surgeons may perform it in an operating room for complex maxillary deformity, such as a developmental midface discrepancy requiring segmental repositioning.
Select this code when the operative report supports both three or more maxillary segments and bone grafting; the number of segments and graft use distinguish it from neighboring LeFort I codes. The record should describe the osteotomy, segment configuration, reconstruction, and grafting. This major surgery has a 90-day global period that 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 others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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.
Where 21147 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,535.21 |
| Seattle (King Cnty) | Unavailable | $1,667.75 |
How the 21147 rate is calculated
Each of 21147’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 · 21147
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 25.81Practice expense 16.11Malpractice 3.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21147
21147 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21147
Midface reconstruction
| 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) | 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 · 21147
Midface reconstruction
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
21147 without 51 · national facility
$1,525.42
Midface reconstruction
21147-51 · Second procedure: 50%
$762.71
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%).
21147 compared with similar codes
Compare codes
21147 vs 21143 vs 21146 vs 21145: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21143LeFort I reconstruction
- Both cover reconstruction in three or more pieces. Choose 21147 when bone grafting is part of the reconstruction; choose 21143 when it is not.
- 21146Midface reconstruction
- This is the grafted LeFort I option for two pieces. Use 21147 when the maxilla is reconstructed in three or more pieces.
- 21145LeFort I reconstruction
- This is the grafted LeFort I option for one piece. Use 21147 when the operative report supports three or more pieces.
21147 billing questions
How does this differ from 21143?
Both describe a LeFort I reconstruction in three or more pieces. This code is for the reconstruction with bone grafting; 21143 is the corresponding option without grafting.
How many segments support this code?
The maxilla must be divided into three or more pieces. The operative report should document the segment configuration rather than relying only on a general description of a LeFort I procedure.
Can the bone graft be reported separately?
Bone grafting is part of the service represented by this code. Do not separately report the same grafting work; assess any distinct graft-harvesting work under applicable coding instructions.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made, while co-surgeons and team surgery are not permitted.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session 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
Fee sheets
Put 21147 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →