Surgical removal of infected or diseased bone tissue from one or more facial bones, typically performed for osteomyelitis or bone abscess that has not responded to antibiotic therapy.

Verified May 8, 2026 · 6 sources ↓

Medicare: $576.17
Total RVUs: 17.25
Global, days: 90
Region: Other

Drawn from CMSCgsmedicareGenhealthMdclarityAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (CT or MRI) confirming osteomyelitis or bone abscess in the specified facial bone(s)
Operative note identifying the specific facial bone(s) excised by anatomic name (e.g., mandible, maxilla, zygoma)
Documentation that conservative treatment (antibiotics) was attempted and failed, or that severity required immediate surgical intervention
Extent of bone removed and description of debridement performed, including any necrotic tissue involvement
Pathology specimen disposition — whether excised bone was sent for culture and/or histopathology
Anesthesia type used and justification for operative setting (hospital vs. ASC)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21026 covers open excision of facial bone — most commonly indicated for osteomyelitis or a bone abscess of the mandible, maxilla, or other craniofacial skeleton. The surgeon incises overlying soft tissue, removes the necrotic or infected osseous segment, and debrides surrounding tissue before closure. This is not a superficial soft-tissue procedure; it requires access to cortical or cancellous bone and is typically performed under general anesthesia in a hospital or ASC setting.

The code carries a 90-day global period. All routine postoperative management through day 90 is bundled — including wound checks, suture removal, and minor debridements. Separate E/M visits within that window require modifier 24 (unrelated) or modifier 25 (significant, separately identifiable on the same day as a minor procedure, though 21026 is not a minor procedure). If the patient requires an unplanned return to the OR for a related problem during the global, bill modifier 78. For a wholly unrelated procedure in the global window, use modifier 79.

This code is predominantly billed by oral and maxillofacial surgeons. Orthopedic and ENT coders encounter it occasionally when craniofacial bone involvement accompanies broader infections or trauma sequelae. The site-of-service differential between HOPD and ASC is substantial — verify the patient's surgical setting before finalizing the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.56
Practice expense RVU	10.94
Malpractice RVU	0.75
Total RVU	17.25
Medicare national rate	$576.17
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	$576.17
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 21026 get rejected.

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

Medical necessity not established — no imaging or failed conservative treatment documented prior to surgery
Operative note lacks specificity on which facial bone(s) were excised; 'facial area' is insufficient for audit defense
Procedure billed with a diagnosis code that doesn't support bone excision (e.g., soft-tissue mass codes when bone involvement isn't documented)
Unbundling of debridement or closure codes that are integral to 21026 without clinically distinct documentation to support separate billing
Global period violations — post-op E/M visits billed without modifier 24 when they fall within the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does 21026 have a global period, and what does it include?

Yes — 21026 carries a 90-day global. The surgery day, the day-before visit, and all routine post-op care through day 90 are bundled. Unrelated E/M visits in that window need modifier 24; an unplanned related return to the OR needs modifier 78.

02Can 21026 be billed bilaterally with modifier 50?

Bilateral facial bone excision is anatomically possible but uncommon. If both sides are genuinely addressed in the same session with distinct pathology on each side, modifier 50 applies. Document each site separately in the operative note — a single description won't support bilateral billing.

03What diagnosis codes most commonly support 21026?

Osteomyelitis codes (M86.x series, site-specific) and bone abscess are the primary ICD-10 drivers. Osteoradionecrosis (M87.18x) and avascular necrosis following radiation therapy also support this code. Avoid soft-tissue or skin-mass diagnosis codes — they signal a mismatch that triggers denial.

04Is a pathology report required to bill 21026?

Medicare doesn't mandate a separate pathology code, but sending excised bone for culture and/or histopathology strongly supports medical necessity in an audit. If tissue is sent, you may separately report the appropriate pathology code — it's not bundled into 21026.

05When should modifier 22 be appended to 21026?

Use modifier 22 when the procedure required substantially greater work than typical — for example, extensive involvement across multiple facial bones, severe scarring from prior surgery, or complex reconstruction after resection. Attach a cover letter quantifying the additional time and effort; without it, most payers will ignore the modifier.

06How does the HOPD vs. ASC payment differential affect site-of-service decisions?

The facility payment gap between HOPD and ASC is significant for 21026 — see the Site of Service comparison table on this page. For cases appropriate to an ASC, payers may scrutinize hospital-based billing if the clinical complexity doesn't justify the higher-cost setting. Document any patient factors that required hospital-level care.

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 specific facial bone(s) involved by anatomic name, the extent of osseous resection, debridement findings, and prior treatment history directly from dictation. This prevents the most common audit flag for 21026 — operative notes that document a 'facial bone procedure' without specifying which bone was excised or why conservative management was insufficient.

See how Mira captures CPT 21026 documentation