No office rate
Use 21194 when the mandibular reconstruction uses a bone graft; 21193 describes the no-graft approach.
On this page
CMS RVU26D · Effective 2026-10-01
21194 Mandible reconstruction Medicare reimbursement rates in Wyoming
Reports reconstruction of the lower jaw using a bone graft to restore a mandibular defect, such as one remaining after tumor removal or trauma. Compare 21194 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 21194 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
$1252.93
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.
Oral and maxillofacial surgery
About 21194: Mandibular reconstruction with bone graft
Reports reconstruction of the lower jaw using a bone graft to restore a mandibular defect, such as one remaining after tumor removal or trauma.
This service reconstructs a defect in the mandible using a bone graft to restore lower-jaw continuity or contour. Oral and maxillofacial surgeons and plastic surgeons may perform it for defects related to trauma, tumor removal, or congenital conditions. The procedure is generally performed in an operating room, with the operative report identifying the mandibular defect and describing the graft reconstruction.
Select this code when the documented reconstruction uses a bone graft; distinguish it from lower-jaw reconstruction without a graft and from variants defined by fixation or segmental work. The record should support the defect treated and the reconstructive technique performed. Medicare assigns a 90-day global period, including 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 other procedures are subject to the standard 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21194
- 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 RVU21.27 · 56%
- Practice expense (office) RVU13.97 · 36%
- Malpractice RVU3.07 · 8%
11
Medicare services in 2024 · #6158 by national volume
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.
21194 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
21195 is identified as lower-jaw reconstruction without fixation, rather than the graft-based reconstruction described by 21194.
No office rate
21196 is identified as lower-jaw reconstruction with fixation. Choose 21194 when the defining service is reconstruction with a bone graft.
Compare 21194 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
$1252.93
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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 21194 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
1,908
- Code
- 21194
- Physician work
- 21.27
- Practice expense
- 13.97
- Malpractice
- 3.07
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.27 | × 1.000 | 21.2700 |
| Practice expense | 13.97 | × 1.000 | 13.9700 |
| Malpractice | 3.07 | × 0.740 | 2.2718 |
| Total RVUs | 37.5118 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$1252.93
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.27 | 1 |
| Practice expense | 13.97 | 1 |
| Malpractice | 3.07 | 0.74 |
(21.27 × 1 + 13.97 × 1 + 3.07 × 0.74) × $33.4009 = $1252.93
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.
21194 billing questions
How is this code distinguished from 21193?
This code describes mandibular reconstruction with a bone graft. Code 21193 is the corresponding lower-jaw reconstruction without a graft.
Does modifier 50 increase Medicare payment?
No. CMS prices this code as bilateral, and modifier 50 does not increase payment.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment may be made. CMS does not permit co-surgeons or team surgery for this code.
How are other procedures performed in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What should the operative report document?
Document the mandibular defect and the use of a bone graft to reconstruct it. The details should make clear why the graft-based service, rather than a no-graft or fixation-defined variant, was performed.
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.
1,90521184,,Reconstruct cranial bone,A,,37.65,19.84,NA,19.84,,7.01,64.50,64.50,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,90621188,,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
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.,,,,,,