No office rate
21137 is for forehead contouring alone; 21138 includes prosthetic material in the reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
21138 Forehead reduction Medicare reimbursement rates in Wyoming
Reports forehead bone reduction and contouring with prosthetic material to restore or shape the forehead, including in craniofacial and gender-affirming surgery. Compare 21138 office and facility rates across CMS payment localities in Wyoming.
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 21138 in Wyoming?
Wyoming has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$806.35
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
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.
Craniofacial surgery
About 21138: Forehead contouring with prosthetic reconstruction
Reports forehead bone reduction and contouring with prosthetic material to restore or shape the forehead, including in craniofacial and gender-affirming surgery.
This operation reduces and reshapes the forehead’s bony contour, with prosthetic material used as part of the reconstruction. It may be performed for prominent brow bossing or other forehead contour concerns, including during gender-affirming facial surgery. Craniofacial, plastic, or oral and maxillofacial surgeons may perform it in a hospital or other surgical setting. The operative report should make clear that forehead reduction and contouring were performed and describe the prosthetic material used in the reconstruction.
Choose this code when the documented procedure includes prosthetic material, rather than contouring alone or contouring with frontal sinus setback. The code has a 90-day global period: the day-before preoperative visit and related postoperative care through 90 days are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21138
- 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
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.55 · 51%
- Practice expense (office) RVU9.86 · 40%
- Malpractice RVU2.34 · 9%
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.
21138 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
21139 describes forehead contouring with setback. Use 21138 when prosthetic material is part of the documented procedure instead.
No office rate
21172 addresses reconstruction involving the supraorbital rims and lateral forehead; 21138 describes forehead contouring with prosthetic material.
No office rate
21175 is for broader bifrontal and supraorbital reconstruction. Select 21138 for the forehead reduction and prosthetic reconstruction documented.
Compare 21138 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.
1 of 1 payment localities
Wyoming** →
Office / nonfacility
Unavailable
Facility
$806.35
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21138 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
1,884
- Code
- 21138
- Physician work
- 12.55
- Practice expense
- 9.86
- Malpractice
- 2.34
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.55 | × 1.000 | 12.5500 |
| Practice expense | 9.86 | × 1.000 | 9.8600 |
| Malpractice | 2.34 | × 0.740 | 1.7316 |
| Total RVUs | 24.1416 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$806.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.55 | 1 |
| Practice expense | 9.86 | 1 |
| Malpractice | 2.34 | 0.74 |
(12.55 × 1 + 9.86 × 1 + 2.34 × 0.74) × $33.4009 = $806.35
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21138 billing questions
How does this differ from 21137?
21137 represents forehead contouring alone. Use 21138 when the documented forehead reconstruction also uses prosthetic material.
How does this differ from 21139?
21139 identifies forehead contouring with setback. This code is distinguished by prosthetic material; document the procedure actually performed.
What documentation supports reporting this code?
The operative report should describe the forehead reduction and contouring and identify the prosthetic material used in reconstruction.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
1,88121125,,Augmentation mndblr prostc,A,,10.53,65.97,,6.39,,1.21,77.71,18.13,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88221127,,Augmentation mndblr b1 grf,A,,12.13,105.28,,7.31,,1.39,118.80,20.83,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88321137,,Rdctj forehead cntrg only,A,,9.98,8.68,NA,8.68,,1.85,20.51,20.51,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88421138,,Rdctj forehead cntrg&prostc,A,,12.55,9.86,NA,9.86,,2.34,24.75,24.75,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88521139,,Rdctj forehead cntrg&setback,A,,14.64,12.11,NA,12.11,,2.72,29.47,29.47,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88621141,,Rcnstj midface lefort i 1pc,A,,19.08,14.34,NA,14.34,,2.76,36.18,36.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,88721142,,Rcnstj midface lefort i 2pcs,A,,19.77,14.43,NA,14.43,,2.87,37.07,37.07,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,