Billing code 21423: Fracture repairMedicare rate & RVUs in Washington
Reports open surgical repair of a palatal or maxillary fracture when its complexity requires multiple surgical approaches for exposure, reduction, or stabilization.
CMS doesn’t publish an office rate for 21423 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 21423 covers
This service is open repair of a fracture involving the palate or maxilla when the complexity calls for multiple surgical approaches. The surgeon exposes the fracture, restores alignment, and stabilizes the involved bones. Oral and maxillofacial surgeons and other facial trauma surgeons commonly perform this work in an operating room, often for displaced injuries that cannot be managed with closed treatment alone.
Choose this code when the operative report supports complicated open repair using multiple approaches; a routine open repair is distinguished from this level. Document the fracture site, displacement and complexity, approaches used, and reduction and fixation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not. Modifier 50 is inappropriate for this code.
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 21423 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $726.80 |
| Seattle (King Cnty) | Unavailable | $796.25 |
How the 21423 rate is calculated
Each of 21423’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 · 21423
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.58Practice expense 9.07Malpractice 1.96
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21423
21423 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21423
Fracture repair
| 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) | 2 | 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 · 21423
Fracture repair
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
21423 without 51 · national facility
$721.79
Fracture repair
21423-51 · Second procedure: 50%
$360.90
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%).
21423 compared with similar codes
Compare codes
21423 vs 21422 vs 21421 vs 21445 vs 21432: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21422Maxillary fracture repair
- Both describe open repair in the palatal or maxillary fracture family. Select 21423 when the repair is complicated and uses multiple approaches; use 21422 for open repair without that distinction.
- 21421Fracture fixation
- 21421 describes closed treatment with wiring. This code describes complicated open treatment through multiple approaches.
- 21445Alveolar fracture
- 21445 is for open treatment of a fracture confined to the mandibular or maxillary alveolar ridge. This code concerns complicated open repair of a palatal or maxillary fracture.
- 21432Craniofacial repair
- 21432 addresses open treatment of craniofacial separation with wiring. Choose this code for a complicated palatal or maxillary fracture repaired through multiple approaches instead.
21423 billing questions
How does this differ from 21422?
Use 21423 when the open repair is complicated and requires multiple approaches. Code 21422 describes open treatment without that added complexity.
When is 21421 more appropriate?
Code 21421 is for closed treatment of a palatal or maxillary fracture with wiring. This code is for complicated open repair using multiple approaches.
What operative documentation supports 21423?
Document the palatal or maxillary fracture, its complexity, the approaches used, and the reduction and stabilization performed. The record should make clear why multiple approaches were needed.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can assistant surgeons or co-surgeons be reported?
CMS permits assistant-at-surgery payment and co-surgeons for this code. Team surgery is not permitted.
Should modifier 50 be appended for bilateral treatment?
No. The descriptor and anatomy make modifier 50 inappropriate for this code.
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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