CPT 21206
Global 090 ActiveReconstruct upper jaw bone
CPT 21206 Billing & Documentation Guide
CPT code 21206 (Reconstruct upper jaw bone) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 15.2, a non-facility practice expense RVU of 9.19, and a malpractice RVU of 1.76, a total non-facility RVU of 26.15 and facility RVU of 26.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $888.74, though rates vary from $801.64 to $1120.84 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21206, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 21206 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 21206 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 21206
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 15.2 | 15.2 |
| Practice Expense RVU | 9.19 | 9.19 |
| Malpractice RVU | 1.76 | 1.76 |
| Total RVU | 26.15 | 26.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21206
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $920.98 | $920.98 | $884.26 - $1037.68 | 29 |
| Florida | $930.11 | $930.11 | $889.5 - $975.9 | 3 |
| Georgia | $871.63 | $871.63 | $851.57 - $891.68 | 2 |
| Illinois | $918.41 | $918.41 | $879.82 - $954.65 | 4 |
| Michigan | $878.67 | $878.67 | $854.31 - $903.02 | 2 |
| North Carolina | $831.65 | $831.65 | $831.65 - $831.65 | 1 |
| New York | $954.12 | $954.12 | $840.63 - $1014.32 | 5 |
| Ohio | $847.2 | $847.2 | $847.2 - $847.2 | 1 |
| Pennsylvania | $875.77 | $875.77 | $845.03 - $906.5 | 2 |
| Texas | $867.29 | $867.29 | $841.63 - $897.45 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 21206
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21206 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 21206
What does CPT code 21206 mean? +
CPT code 21206 represents: Reconstruct upper jaw bone. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21206? +
The 2026 Medicare national average non-facility payment for CPT 21206 is $888.74. Rates range from $801.64 to $1120.84 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21206? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 21206? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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