Surgical · Other

Surgical removal of infected or necrotic bone from the mandible, performed to treat osteomyelitis or bone abscess unresponsive to conservative management.

Verified May 8, 2026 · 8 sources ↓

Medicare: $840.03
Total RVUs: 25.15
Global, days: 90
Region: Other

Drawn from CMSFindacodeGenhealthAAPCAaoms

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Diagnosis driving surgery — confirm infectious/inflammatory etiology (osteomyelitis, bone abscess) with supporting imaging or culture results, not neoplastic pathology
Failure of non-surgical treatment — document prior antibiotic course, duration, and clinical response before proceeding to surgical excision
Operative note must specify extent and location of bone removed, including whether sequestrum was present and removed
Pathology specimen disposition — note whether excised bone was sent for culture and/or histopathology to substantiate infectious indication
Approach documented explicitly (intraoral vs. extraoral) to support complexity and distinguish from adjacent codes requiring specific osteotomy approaches
If +20700 is billed concurrently, document placement of the drug-delivery device type, location (deep/subfascial), and clinical rationale

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 21025 covers open excision of diseased or necrotic mandibular bone — most commonly for osteomyelitis or a bone abscess that failed antibiotic therapy. The surgeon debrides and removes the affected osseous tissue, which may include sequestrectomy and curettage of surrounding infected marrow. The extent of resection is driven by intraoperative findings; the code does not distinguish between partial and subtotal mandibular resection for infectious indications.

This code sits within the head excision family alongside 21026 (facial bones), 21040 (benign mandibular tumor/cyst by enucleation), and 21044/21045 (malignant mandibular tumor). Choosing the wrong code in this group is a top audit trigger — 21025 is appropriate when the underlying pathology is infectious or inflammatory, not neoplastic. If a benign lesion is excised with intraoral osteotomy, 21046 applies instead. If the operative report documents a malignant indication, 21044 or 21045 is required.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Add-on code +20700 (manual preparation and insertion of drug-delivery device, deep) is reportable separately when a local antibiotic delivery system is placed at the time of surgery — 21025 is explicitly listed in +20700's use-with list. Bilateral mandibular involvement is rare anatomically, and modifier 50 is generally not appropriate here; AAPC forum consensus flags bilateral use of 21025 with modifier 50 as likely incorrect.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.78
Practice expense RVU	14.06
Malpractice RVU	1.31
Total RVU	25.15
Medicare national rate	$840.03
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$840.03
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21025 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code family — billing 21025 when operative report documents a benign or malignant neoplasm instead of an infectious/inflammatory indication
Insufficient medical necessity — no documented failure of conservative management (antibiotics) prior to surgical intervention
Missing or inadequate imaging — payers expect pre-op radiograph, CT, or MRI confirming mandibular bone destruction or abscess before approving surgical excision
Modifier 50 appended incorrectly — bilateral mandibular excision billed with modifier 50 is routinely flagged; most payers reject this combination for 21025
Global period violation — post-op E/M visits billed without modifier 24 during the 90-day global period are denied as bundled
Site-of-service mismatch — procedure billed with a facility rate when performed in a non-facility setting, or vice versa

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When does 21025 apply versus 21044 or 21040?

21025 is for infectious or inflammatory mandibular bone excision — osteomyelitis, bone abscess. Use 21040 for benign tumor or cyst removed by enucleation/curettage, 21046 when that requires an intraoral osteotomy, and 21044/21045 for malignant mandibular tumors. The underlying pathology, not the surgical technique alone, drives code selection.

02Can 21025 be billed with modifier 50 for bilateral involvement?

Generally no. The mandible is a single U-shaped bone, and bilateral excision is anatomically unusual. AAPC coding forums flag modifier 50 on 21025 as incorrect, and payer code-correct systems typically reject it. If disease truly spans both sides, document the distinct sites and consider modifier 59 with payer pre-authorization rather than modifier 50.

03Is add-on code +20700 billable at the same time as 21025?

Yes. CPT 20700 (manual preparation and insertion of drug-delivery device, deep) explicitly lists 21025 as a primary code it can be appended to. If you pack a local antibiotic carrier or PMMA bead pouch into the resection site, report +20700 in addition to 21025 with documentation of device type and placement depth.

04What global period applies, and what does that mean for post-op billing?

21025 carries a 90-day global period. Routine post-op visits, wound checks, and suture removal through day 90 are bundled into the surgical fee. To bill an E/M visit during that window for an unrelated condition, append modifier 24. For a new and significant problem arising from the surgery that requires a separate decision, modifier 24 also applies with clear documentation.

05Does 21025 require prior authorization, and what should the auth request include?

Most commercial payers require prior auth for this procedure. The auth request should include the confirmed diagnosis (ICD-10: typically M27.2 for inflammatory conditions of jaws), imaging reports documenting bone destruction, documentation of failed conservative treatment, and the planned surgical approach. Missing any of these elements is a common reason auth is delayed or denied.

06What ICD-10 codes are typically paired with 21025?

M27.2 (Inflammatory conditions of jaws, including osteomyelitis) is the primary pairing. K10.2 (Inflammatory conditions of jaws) may also apply depending on payer preference. Pairing 21025 with a neoplasm ICD-10 code is a coding mismatch that triggers review and often denial.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the infectious indication (osteomyelitis vs. abscess), prior treatment failure documentation, approach (intraoral or extraoral), anatomic extent of resection, presence of sequestrum, specimen handling, and any concurrent drug-delivery device placement from surgeon dictation. This prevents the most common denial trigger for 21025 — an operative note that describes bone removal without explicitly tying it to an infectious etiology, which causes payers to recode toward the neoplasm family or deny for missing medical necessity.

See how Mira captures CPT 21025 documentation