Surgical · Other

Open surgical excision of a malignant tumor from the mandible (lower jaw bone), performed via intraoral or extraoral approach.

Verified May 8, 2026 · 6 sources ↓

Medicare: $764.88
Total RVUs: 22.9
Global, days: 90
Region: Other

Drawn from CMSAaomsAAPCAxogenincMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pathology report confirming malignant histology — required before claim submission per AAOMS best practices
Operative note specifying surgical approach: intraoral vs. extraoral
Lesion size, location within the mandible, and depth of invasion documented in the operative report
ICD-10-CM code mapped to the confirmed malignancy with highest specificity (primary vs. secondary, specific mandibular site)
Documentation distinguishing excision from radical resection to support 21044 over 21045
Surgeon attestation that the specimen was sent for pathological evaluation

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21044 covers open removal of a malignant lesion from the mandible. The surgeon accesses the lesion either through the mouth (intraoral) or through a skin incision (extraoral), depending on lesion location, size, and extent of invasion. The procedure sits under the Excision Procedures on the Head section of the musculoskeletal CPT range (21011–21070).

Select 21044 specifically for malignant mandibular tumors requiring open excision that falls short of radical resection. Radical resection of the mandible maps to 21045, not 21044. Benign mandibular tumors requiring intraoral osteotomy map to 21046; those requiring extraoral osteotomy and partial mandibulectomy map to 21047. Code selection hinges on the pathology report — per AAOMS guidance, delay claim submission until the written pathology report confirms malignancy.

The 90-day global period covers the day-before visit, the procedure, and all routine post-op management through day 90. Bill unrelated E/M services within that window with modifier 24. If a staged or related procedure follows in the global, use modifier 58. An unplanned return to the OR for a related complication takes modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.48
Practice expense RVU	8.57
Malpractice RVU	1.85
Total RVU	22.9
Medicare national rate	$764.88
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	$764.88
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 21044 get rejected.

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

Claim submitted before pathology report returned, resulting in mismatched or unspecified diagnosis code
Upcoding flag when 21044 is billed for lesions meeting radical resection criteria (should be 21045)
Missing operative note detail on approach (intraoral vs. extraoral) triggering medical necessity review
Bundling denial when a same-session biopsy is billed separately — if biopsy and definitive excision occur in the same encounter, only the excision is reportable
Global period violation — post-op E/M billed without modifier 24 within the 90-day window

Frequently asked questions

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

01What is the difference between 21044 and 21045?

21044 is open excision of a malignant mandibular tumor. 21045 is radical resection of that same tumor — a more extensive resection with broader bone and soft-tissue removal. If your operative note describes radical resection, bill 21045, not 21044.

02Can I bill the biopsy separately if it was done in the same session as the excision?

No. If the biopsy and the definitive therapeutic excision are performed in the same operative encounter on the same site, only the excision is reported. Per AAOMS coding guidance, the biopsy is bundled into the excision code.

03Should I hold the claim until pathology results are back?

Yes. AAOMS explicitly recommends delaying claim submission until the written pathology report is received. Submitting early with an unspecified or presumptive diagnosis code is a common trigger for denial and audit scrutiny.

04Does site of service affect payment for 21044?

Yes. HOPD and ASC payments differ — see the Site of Service comparison on this page for current 2026 figures under CMS OPPS and ASC payment systems.

05What modifier applies if a complication requires return to the OR within the 90-day global?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Use modifier 79 if the return procedure is unrelated to the original surgery.

06How does modifier 22 apply to 21044?

If the procedure required substantially greater work than typical — for example, due to extensive tumor involvement, difficult anatomy, or prolonged operative time — append modifier 22 and include a cover letter documenting the increased complexity. Without supporting documentation, payers will strip the modifier and revert to base payment.

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 surgical approach (intraoral vs. extraoral), lesion characteristics, extent of bone involvement, and confirmation that the specimen was sent for pathological analysis. It flags if the dictation describes radical resection language that would shift the code to 21045, preventing a post-submission audit downcode. The scribe also notes the procedure date so the 90-day global period is correctly tracked for subsequent visit billing.

See how Mira captures CPT 21044 documentation