Surgical · Other

Surgical removal or resection of the mandible involving extensive bone and soft tissue work, typically indicated for aggressive tumors, severe infection, or significant traumatic defect requiring wide-field operative exposure.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,061.15
Total RVUs: 31.77
Global, days: 90
Region: Other

Drawn from CMSCgsmedicareMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the pathologic indication (malignancy, osteonecrosis, trauma, etc.) with supporting biopsy or imaging
Describe the exact anatomic extent of resection — partial mandibulectomy, segmental, marginal, or hemimandibulectomy — not just 'extensive'
Document surgical margins, structures removed, and any simultaneous reconstruction performed
Include pre-operative imaging (CT or MRI) confirming the extent of disease requiring radical resection
Record intraoperative findings that justify the scope of surgery, particularly if modifier 22 is appended
Pathology report confirming diagnosis should be linked to the operative encounter in the medical record

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21045 covers extensive mandibular surgery — the kind requiring radical resection of bone, often with surrounding soft tissue, performed for malignancy, osteonecrosis, or severe pathology that cannot be addressed by a limited excision. The 90-day global period means all routine follow-up through that window is bundled. Separate visits during that period require modifier 24 (unrelated E/M) or 79 (unrelated return procedure).

A critical NCCI bundling rule governs this code: CPT 21044 (excision of malignant mandibular tumor) is considered a component of 21045 and cannot be billed alongside it on the same date of service. Per the CMS Medicaid NCCI Correspondence Language Manual, the procedure described by 21044 is a subset of the more extensive work captured by 21045 — billing both will trigger a column-two denial with no modifier bypass allowed.

Site of service matters. HOPD and ASC reimbursements differ substantially; see the site-of-service comparison table on this page. The procedure almost always requires inpatient or outpatient hospital setting, and payers will scrutinize facility claims closely. Pre-authorization is standard across most commercial plans and Medicare Advantage. Documentation must clearly justify the extent of resection — operative notes that vaguely describe 'extensive jaw surgery' without specifying pathology, anatomic margins, or resection type are a top audit flag.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.91
Practice expense RVU	11.15
Malpractice RVU	2.71
Total RVU	31.77
Medicare national rate	$1,061.15
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	$1,061.15
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21045 get rejected.

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

Simultaneous billing of CPT 21044 — it bundles into 21045 with no modifier override permitted
Operative note lacks specificity about resection extent, flagged as insufficient to support the code level
Missing or expired prior authorization, especially for Medicare Advantage and commercial plans
Medical necessity not established due to absent pre-op imaging or pathology documentation
Site-of-service mismatch — procedure billed under a non-facility rate when performed in a hospital setting

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill CPT 21044 and 21045 together on the same date?

No. CMS NCCI edits treat 21044 as a component of 21045. The column-two denial has a modifier indicator of 0 — no modifier bypass is permitted. Bill only 21045 when the work meets its scope.

02What modifier applies if the surgery was significantly more complex than typical?

Append modifier 22 and include a separate cover letter quantifying the additional time, difficulty, or unusual anatomic findings. Payers expect documentation beyond the operative note alone to support a 22 payment bump.

03Does the 90-day global period include reconstructive follow-up visits?

Routine post-op visits are bundled. If reconstruction-related complications or unrelated problems require separate E/M services, use modifier 24 (unrelated E/M) or 79 (unrelated return procedure) with supporting documentation.

04Is prior authorization required for 21045?

Yes, for virtually all commercial plans and most Medicare Advantage products. Confirm auth requirements before scheduling — retroactive auth denials on a procedure with this RVU value are costly and rarely overturned on appeal without documented pre-auth attempts.

05Can a co-surgeon be billed on this procedure?

Yes. If two surgeons each perform distinct portions of the procedure, both may bill 21045 with modifier 62. Each surgeon's operative note must describe their specific contribution. If one surgeon serves as an assistant, modifier 80 or AS (for non-physician practitioners) applies instead.

06What diagnosis codes are typically paired with 21045?

Malignant neoplasm of the mandible (C41.1) is the most common primary indication. Osteonecrosis of the jaw (M87.18x), medication-related osteonecrosis (M87.180), and post-traumatic bone defect codes are also used depending on clinical context. The ICD-10 must match the documented pathology.

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 resection type (marginal, segmental, hemimandibulectomy), anatomic boundaries, pathologic indication, and intraoperative findings from dictation — structured directly into the operative note. This prevents the single most common audit flag for 21045: an operative note that documents 'extensive jaw surgery' without specifying what was resected, how far, and why the extent was medically necessary.

See how Mira captures CPT 21045 documentation