Billing code 21209: Facial bone reductionMedicare rate & RVUs in Washington
Reports operative reshaping that reduces facial bone prominence, such as contouring an overprominent facial bone rather than augmenting or grafting it.
Medicare pays $825.21–$926.21 for 21209 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
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 21209 covers
A surgeon reduces a prominent facial bone by removing or reshaping bone to change its contour. Plastic surgeons and oral and maxillofacial surgeons may perform this as facial skeletal contouring when the operative goal is to decrease bony prominence, rather than reconstruct a jaw or add volume with graft or implant material. The operative report should identify the bone treated and describe the reduction performed.
Report the service for the documented reduction, not for facial bone augmentation or bone grafting. Documentation should establish the treated site, the bony work performed, and the reason for contour reduction. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; 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 21209 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $825.21 | $563.53 |
| Seattle (King Cnty) | $926.21 | $621.30 |
How the 21209 rate is calculated
Each of 21209’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 · 21209
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.62Practice expense 15.46Malpractice 0.93
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21209
21209 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21209
Facial bone reduction
| 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 · 21209
Facial bone reduction
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
21209 without 51 · national office
$801.96
Facial bone reduction
21209-51 · Second procedure: 50%
$400.98
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%).
21209 compared with similar codes
Compare codes
21209 vs 21208 vs 21270 vs 21206: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21208Bone augmentation
- 21209 reduces facial bone prominence; 21208 addresses facial bone augmentation. Select based on whether the operation removes or reshapes bone to reduce prominence or adds volume.
- 21270Cheek augmentation
- 21270 is for cheekbone augmentation. Use 21209 when the documented procedure reduces facial bone prominence rather than augmenting the cheekbone.
- 21206Maxillary osteotomy
- 21206 describes reconstruction of the upper jaw. It is distinct from reduction performed to contour a facial bone without reconstructing the maxilla.
21209 billing questions
How is reduction distinguished from facial bone augmentation?
Use 21209 when the operative goal is to reduce bony prominence. Code 21208 describes augmentation of facial bones, an opposite contouring goal.
Should modifier 50 be reported for reduction on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports reporting 21209?
The operative report should identify the facial bone treated and describe the bone removal or reshaping that reduced its prominence.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code under the CMS rules provided.
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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