No office rate
21193 identifies lower-jaw reconstruction without a graft. Use 21195 when the documented distinction is reconstruction without fixation.
On this page
CMS RVU26D · Effective 2026-10-01
21195 Jaw reconstruction Medicare reimbursement rates in Washington
Reconstructive surgery of the lower jaw without fixation is reported when the operative work rebuilds the mandible without fixation. Compare 21195 office and facility rates across CMS payment localities in Washington.
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 21195 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1230.60–$1346.28
2 of 2 localities have a supported rate.
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.
Oral and maxillofacial surgery
About 21195: Mandibular reconstruction without fixation
Reconstructive surgery of the lower jaw without fixation is reported when the operative work rebuilds the mandible without fixation.
This code describes reconstructive surgery of the mandible, the lower jaw, performed without fixation. Oral and maxillofacial surgeons and other surgeons who perform craniofacial reconstruction may use it for operative repair of a mandibular defect or deformity. The operative report should make clear that the work reconstructs the lower jaw and that fixation is not part of the reported service; routine dental treatment or a procedure limited to another facial bone is not this service.
Report the code when the documented reconstruction matches these features. The 90-day global period includes 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. The code is priced as bilateral, so modifier 50 does not increase payment. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 21195
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.68 · 51%
- Practice expense (office) RVU15.06 · 41%
- Malpractice RVU2.71 · 7%
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.
21195 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
21194 identifies lower-jaw reconstruction with a graft. Use 21195 when the documented distinction is reconstruction without fixation.
No office rate
21196 is the neighboring fixation option. The operative report should distinguish reconstruction performed with fixation from reconstruction without it.
Compare 21195 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$1230.60
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$1346.28
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21195 billing questions
How does this differ from 21193 or 21194?
Those neighboring codes distinguish lower-jaw reconstruction by graft use: 21193 without a graft and 21194 with a graft. Choose based on the documented procedure and the code descriptor that matches it.
Can modifier 50 be used for bilateral work?
The code is already priced as bilateral, so modifier 50 does not increase payment.
Can an assistant surgeon be reported?
CMS allows payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
What happens if 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 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.
1,90621188,,Reconstruction of midface,A,,22.57,16.94,NA,16.94,,3.27,42.78,42.78,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90721193,,Reconst lwr jaw w/o graft,A,,18.43,12.08,NA,12.08,,2.68,33.19,33.19,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90821194,,Reconst lwr jaw w/graft,A,,21.27,13.97,NA,13.97,,3.07,38.31,38.31,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90921195,,Reconst lwr jaw w/o fixation,A,,18.68,15.06,NA,15.06,,2.71,36.45,36.45,0,090,0.10,0.69,0.21,2,2,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91021196,,Reconst lwr jaw w/fixation,A,,20.31,15.56,NA,15.56,,2.95,38.82,38.82,0,090,0.10,0.69,0.21,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91121198,,Reconstr lwr jaw segment,A,,15.32,9.88,NA,9.88,,2.01,27.21,27.21,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,91221199,,Reconstr lwr jaw w/advance,A,,16.31,8.45,NA,8.45,,2.37,27.13,27.13,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00